Royal Australasian College of Surgeons Progress Report

Royal Australasian College of SurgeonsProgress Report 2018Australian Medical Council

Progress Report 2018

Royal Australasian College of Surgeons

Contact:

College of Surgeons Gardens

250-290 Spring Street

East Melbourne VIC 3002

Australia

New Zealand Office

Level 3, 8 Kent Terrace

Mount Victoria

Wellington 6011

Telephone: +64 4 385 8247

Email: [email protected]

Postal address:

PO Box 7451

Newtown

Wellington 6242

Date of last AMC accreditation decision: December 2017

Periodic reports since last AMC assessment: NIL

Next accreditation decision due: March 2022 (Follow-up assessment)

This report due: Monday 27 August 2018 (Extended to 4 September 2018)

Progress Report contacts

Ms Zaita Oldfield

Manager, Education Development and Research

Telephone: +61 3 9276 7479


Ms Robin Buckham

Interim Executive General Manager Education

Telephone: +61 3 9249 7461


Contributors to the report

This report has been compiled with significant advice and input from specialty society and training board

representatives and RACS office-bearers and staff. Detailed information provided by individual specialty

training programs is presented verbatim in Appendix 10. Ms Kathleen Hickey’s contributions to the

preparation of the report are particularly acknowledged.

Verify report reviewed

The information presented to the AMC is complete, and it represents an accurate response to the relevant

requirements.

Ms Mary Harney, Chief Executive Officer

Telephone: +61 3 9249 1205


mailto:[email protected]





Table of Contents


i

Table of contents

Standard 1: The context of training and education .................................................... 1

Summary of significant developments ........................................................................................ 1

Recommendations for improvement ........................................................................................... 2

Activity against conditions........................................................................................................... 2

Condition 1 ......................................................................................................................................................... 2

Condition 2 ......................................................................................................................................................... 2

Condition 3 ......................................................................................................................................................... 3

Condition 4 ......................................................................................................................................................... 3

Statistics and annual updates ...................................................................................................... 4

Reconsideration, reviews and appeals .............................................................................................................. 4

Governance Policies/Procedures ...................................................................................................................... 5

Standard 2: The outcomes of specialist training and education ................................... 6




Condition 5 ......................................................................................................................................................... 7

Condition 6 ......................................................................................................................................................... 7

Condition 7 ......................................................................................................................................................... 8

Statistics and annual updates ...................................................................................................... 8

Standard 3: The specialist medical training and education framework ........................ 9




Condition 8 ......................................................................................................................................................... 9

Condition 9 ....................................................................................................................................................... 10

Condition 10 ..................................................................................................................................................... 10

Condition 11 ..................................................................................................................................................... 10

Condition 12 ..................................................................................................................................................... 10

Condition 13 ..................................................................................................................................................... 11

Statistics and annual updates .................................................................................................... 11

Standard 4: Teaching and learning approach and methods ........................................ 12

Summary of significant developments ...................................................................................... 12

Recommendations for improvement ......................................................................................... 12

Activity against conditions......................................................................................................... 12

Table of Contents


ii

Condition 14 ..................................................................................................................................................... 12


Standard 5: Assessment of learning .............................................................................. 13




Condition 15 ..................................................................................................................................................... 13

Condition 16 ..................................................................................................................................................... 14


Standard 6: Monitoring and evaluation .......................................................................... 16




Condition 17 ..................................................................................................................................................... 16

Condition 18 ..................................................................................................................................................... 16

Condition 19 ..................................................................................................................................................... 17

Condition 20 ..................................................................................................................................................... 17

Condition 21 ..................................................................................................................................................... 18

Condition 22 ..................................................................................................................................................... 18

Condition 23 ..................................................................................................................................................... 18


Standard 7: Issues relating to trainees .......................................................................... 21




Condition 24 ..................................................................................................................................................... 22

Condition 25 ..................................................................................................................................................... 22

Condition 26 ..................................................................................................................................................... 24

Condition 27 ..................................................................................................................................................... 24

Condition 28 ..................................................................................................................................................... 25

Condition 29 ..................................................................................................................................................... 25


Trainees entering, completing and currently in training ................................................................................... 26

Selection into training ...................................................................................................................................... 28

Standard 8: Implementing the program – delivery of education and

accreditation of training sites................................................................ 29


Table of Contents


iii



Condition 30 ..................................................................................................................................................... 30

Condition 31 ..................................................................................................................................................... 30

Condition 32 ..................................................................................................................................................... 30

Condition 33 ..................................................................................................................................................... 31


Standard 9: Continuing professional development, further training and

remediation ............................................................................................. 32





Standard 10: Assessment of specialist international medical graduates ................... 34



Condition 34 ..................................................................................................................................................... 35

Condition 35 ..................................................................................................................................................... 35


Table of Contents


iv

List of tables

Table 1 Requests for reconsideration ................................................................................................................ 4

Table 2 Requests for review .............................................................................................................................. 5

Table 3 Requests for appeal ............................................................................................................................. 5

Table 4 RACS governance (policies and procedures) ...................................................................................... 5

Table 5 Examination pass rates ...................................................................................................................... 15

Table 6 Evaluation of activities ........................................................................................................................ 19

Table 7 Specialty standards of entry into SET ................................................................................................ 22

Table 8 Number of trainees entering training program .................................................................................... 26

Table 9 Number of trainees completing training program ............................................................................... 27

Table 10 Number and gender of trainees undertaking each training program................................................ 27

Table 11 SET and IMG supervisors’ and trainers’ completion of OWR and FSSE face-to-face course ......... 30

Table 12 Site accreditation activities .............................................................................................................. 31

Table 13 Fellows participating in and meeting the RACS CPD program requirements .................................. 33

Table 14 Non-fellows participating in and meeting the RACS CPD program requirements ........................... 33

Table 15 New Applicants undertaking specialist international medical graduate assessment ....................... 35

Table 16 Number of specialist international medical graduates assessments (1/08/2017-31/07/2018) ......... 36

Summary of appendices

Appendix 1: RACS Executive Leadership Team 39

Appendix 2: Policy REL-GOV-11 Appeals Mechanism 40

Appendix 3: Education program of works 2018-2020 43

Appendix 4: Flexible training posts 48

Appendix 5: Responding to trainees who provide Feedback 50

Appendix 6: ANZ Journal of Surgery articles 52

Appendix 7: Surgical News article 60

Appendix 8: RACS Activities Report 2017 63

Appendix 9: Guidelines: Standards for supervision 131

Appendix 10: Specialty responses 141

Table of Contents


v

List of acronyms

AIDA Australian Indigenous Doctors’ Association

AMC Australian Medical Council

AOA Australian Orthopaedic Association

ASC Annual Scientific Congress

ASE Academy of Surgical Educators

ASERNIP-s Australian Safety and Efficacy Register of New Interventional Procedures - surgical

ASM Annual Scientific Meeting

ASSET Australian and New Zealand Surgical Skills Education and Training

Au Australia

BRIPS Building respect, improving patient safety

BSET Board of Surgical Education and Training

CCrISP® Care of the Critically Ill Surgical Patient

CEO Chief Executive Officer

CIC Censor-in-chief

CLEAR Critical Literature Evaluation and Research

CPD Continuing Professional Development

CV Curriculum vitae

DBSH Discrimination bullying and sexual harassment

DOPS Direct observation of procedural skills

EGM Executive General Manager

EMST Early Management of Severe Trauma

FSSE Foundation Skills for Surgical Educators (course)

IMG International medical graduate

MCNZ Medical Council of New Zealand

MiniCEX Mini clinical evaluation exercise

MOU Memorandum/a of understanding

MSF Multi-source feedback

NSW New South Wales

NZ New Zealand

NZAPS New Zealand Association of Plastic Surgeons

NZBPRS New Zealand Board of Plastic and Reconstructive Surgery

OPBS Orthopaedic Principles and Basic Science (Examination)

OWR Operating with respect (course)

PRS Plastic and Reconstructive Surgery

PRSSP Plastic and Reconstructive Surgical Science and Principles (Examination)

PSEC Prevocational and Skills and Education Centre

QLD Queensland

RACS Royal Australasian College of Surgeons

RACSTA Royal Australasian College of Surgeons Trainee Association

SA South Australia

Table of Contents


vi

SET Surgical Education and Training

STP Specialist Training Program

TIPS Training in Professional Skills

TOR Terms of reference

VIC Victoria

WA Western Australia

Standard 1: The context of training and education


1


Areas covered by this standard: governance of the college; program management; reconsideration, review and appeals processes; educational expertise and exchange; educational resources; interaction with the health sector; continuous renewal.

Summary of significant developments

With the appointment of a new Chief Executive Officer (CEO), Mary Harney, in October 2017, a comprehensive review of RACS’ governance and operational structures commenced. The review incorporated extensive consultation with RACS Council, and RACS staff, state and territory and New Zealand committees, specialty societies, and specialty training boards.

In response to the review findings, improvements to RACS organisational and governance structures have commenced. Priorities include improving the effectiveness and efficiency of RACS with a focus on delivering value to Fellows, trainees and International Medical Graduates. A new Executive Leadership Team has been established incorporating the Deputy CEO position, held by John Biviano, with three new roles. Emily Wooden, Chief Operating Officer, and Susan Wardle, Executive General Manager (EGM) Partnerships, have commenced, and the appointment of a new EGM Education is pending, with the appointment of Robin Buckham as the interim EGM Education. With the creation of these senior positions, there have been corresponding changes to the reporting lines of some departments. Education activities across the continuum of learning are now grouped under the direction of the EGM Education. The new organisational structure is described in the RACS Executive Leadership Team plan (Appendix 1).

Changes to committee structures are being undertaken to enable a more streamlined and focussed approach to governance. The Board of Regional Chairs and the Governance and Advocacy Board have been merged into a new Advocacy Board. With a broad vision to promote advocacy across RACS, the new board brings together state, territory and New Zealand chairs and specialty representatives (from the nine key surgical specialities) with other relevant groups.

Benefits from these changes are likely to include better alignment of RACS’ structure to strategic priorities, bringing key functions and expertise together (e.g. Education), and being more inclusive of New Zealand and Australian regions and enhancing the focus of activities to Fellows, trainees and IMGs.

RACS’ management and the specialty societies and speciality training boards have consulted and continue to interact to share information and develop collaborative projects. The President and the CEO have met with all 13 specialty societies. The Dean of Education regularly attends meetings of the speciality training boards and convened a selection workshop involving all specialties in April 2018.

Significant activities include:

Discussion of the amalgamation of the Board of Surgical Education and Training and the Education Board has commenced. See progress against Condition 1.

An evaluation framework has been instigated to monitor implementation and outcomes of the Building Respect, Improving Patient Safety Action Plan. Relevant evaluation is to be implemented in three phases over ten years, with the final phase planned for implementation in 2026. Governance and reporting of findings, including recommendations for program adjustment, are through RACS Council.

The first annual external review of the complaints handling process has been completed by an Independent Complaints Process Reviewer. The external review and oversight of the process provide assurance that RACS’ handling of discrimination, bullying and sexual harassment (DBSH) complaints has been undertaken appropriately and that due process has been addressed. An annual report is provided to RACS Council and published on the RACS website.

An internal review of the management of the complaints area, with a focus on risk management will commence in July 2018.



2

A collaborative initiative with St Vincent Health Australia (SVHA) is working towards a model for the sharing

of information on complaints made about Fellows, trainees and IMGs. SVHA has recently implemented

their ETHOS system.

Consistent with other medical colleges, and to allow for review and evaluation, from September 2018,

RACS will cease ISO accreditation. A decision to re-accrediting with ISO will be considered in 2019.

A review of the digital platform is about to commence.

Significant advocacy has been undertaken in the areas of excessive fees and out of pocket costs, impact

of private health insurance, rural health and indigenous health.

Recommendations for improvement

AA Broaden the definition of conflict of interest to include reflection on an individual’s demography, committee roles, public positions or research interests that may bias decision making in areas such as selection or specialist international medical graduate assessment

No significant developments

Activity against conditions

Condition 1 Review the relationships between Council, the Education Board, the Board of Surgical Education and Training and the specialty training boards to ensure that the governance structure enables all training programs to meet RACS policies and AMC standards.

To be met by: 2019

Consultation on the governance structure for training, with the focus on amalgamation of the Board of Surgical

Education and Training and the Education Board, has commenced. The Censor-in-Chief is leading a working

party to determine options; a proposed restructure of the two boards will be discussed with the Speciality

Training Boards and Societies in October 2018.

Condition 2 RACS must develop and implement a stronger process for ongoing evaluation as to whether each of these programs remain consistent with the education and training policies of the College.

To be met by: 2020

The speciality training boards have expressed willingness to work with RACS’ management to align specialty

regulations with RACS’ education and training policies. The conditions of the service agreements between

RACS and the specialty societies will be integral in achieving this condition. Discussion on updating the

agreements will commence in late 2018.

Consistent use of the Surgical and Education and Training (SET) policies by the specialty training boards will

also be reviewed as the overarching evaluation framework for education is developed in 2019 (Condition 17).



3

Condition 3 Develop a common policy that makes it explicit that all specialty training boards must develop and implement defined reconsideration, review and appeals policies which clearly outline the processes for each of the three phases.

To be met by: 2018

The RACS Appeals Mechanism policy (V5, 2014. See Appendix 2) is the common policy adhered to by all

specialty training boards, and referenced in all training regulations. It should be noted that some appeals are

managed directly by the Australian Orthopaedic Association (AOA) applying the same principles as described

in the RACS Appeals Mechanism.

The RACS Appeals Mechanism is currently under review to streamline the process to provide greater clarity.

The revised policy will more clearly encompass and define reconsideration and review as the first two stages

related to any issues raised by SET trainees or IMG surgeons under supervision. Formal appeal would be

available when matters have not been resolved.

At the February and June 2018 meetings of the Board of Surgical Education and Training (BSET), the specialty

training board chairs discussed the AMC condition requiring clearly outlined processes for reconsideration and

review, noting the AMC considered the AOA and Neurological Society of Australia (NSA) processes as

exemplars. The boards were asked to ensure that specialty regulations articulate process for reconsideration

and review, adhering to the principles described in the RACS Appeals Mechanism.

Each speciality training board will confirm that they have articulated defined processes for reconsideration,

review and appeal in their regulations at the BSET meeting in October 2018. (See Appendix 10 for specialty

training program responses).

Condition 4 Provide evidence of effective implementation, monitoring and evaluation of the: (i) Reconciliation Action Plan (ii) Building Respect, Improving Patient Safety Action Plan (iii) Diversity and Inclusion Plan.

To be met by: 2021

Reconciliation Action Plan (RAP) (Australia)

There are 21 actions arising from the RACS Reconciliation Action Plan 2016-2017(Au), of which 17 have been

completed with four continuing to progress, including:

The appointment of senior Torres Strait Islander Professor Martin Nakata (James Cook University,

Townsville) as an education adviser to RACS.

Making available $130,000 in scholarships annually for Aboriginal and Torres Strait Islanders pursuing

careers in surgery.

Guaranteeing training positions for Aboriginal applicants who meet the standard for selection (Refer

condition 26).

Providing cultural competence training for 80 RACS staff.

Maintaining a focused advocacy campaign to improve ear health outcomes in Aboriginal communities.

Building relationships with other organisations pursuing reconciliation including the Australian Indigenous

Doctors’ Association (AIDA), the Leaders in Medical Education (LIME) and National Aboriginal Community

Controlled Health Organisation (NACCHO).

Work has begun on the next RAP (2019-2020) (Au) and will focus on working with surgical societies and

associations and mainstreaming Aboriginal and Torres Strait Islander health and cultural competence across

the breadth of RACS speciality curricula.

https://www.surgeons.org/policies-publications/policies/appeals/



4

Diversity and Inclusion Plan (New Zealand)

The Diversity and Inclusion plan (NZ) was developed as an action arising from implementing the Action plan.

It is written to complement the existing Reconciliation Action Plan and Māori Health Action Plan. Achievements

for the latter include:

Annual scholarships are available for Māori doctors and medical students interested in pursuing surgical

careers.

A strong relationship exists with Te Ohu Rata o Aotearoa (Te ORA, the Māori Medical Pract itioners

Association) and RACS has provided sponsorship for its annual hui–a–tau. Relationships also exist with

staff in Māori health units in other organisations such as Health Quality and Safety Commission and other

medical colleges.

Māori health presentations are a requirement in NZ’s Annual Surgeons Meeting; and articles are published

regularly in the RACS’ Surgical News.

Selection interviews in 2018 for training in New Zealand included assessment of cultural competence

scenarios; and a workshop is planned for later this year with NZ training chairs to develop further inclusion

of Māori tikanga into selection and training.

A Māori name for RACS, Te Whare Piki Ora o Māhutonga, and a Māori motif have been approved and are

in use.

Māori welcomes are used at all NZ skills courses and RACS meetings.

All RACS NZ staff attended Treaty of Waitangi training.

Other actions advanced under the Diversity and Inclusion plan are captured in the evaluation framework of the

Building Respect Action Plan.

Building Respect and Improving Patient Safety Action Plan (Action Plan)

RACS has instigated an evaluation framework to monitor the implementation and outcomes of the Action Plan

in three phases, over ten years. The evaluation framework includes research questions, indicators, and data

sources based on bespoke program logic as the first phase. The evaluation framework will enable RACS to

ensure that appropriate data is gathered to measure progress and outcomes of activities contained in the

Action Plan. Modifications of the Action Plan may come from this evaluation process.

Statistics and annual updates

Reconsideration, reviews and appeals

The number of reconsiderations, reviews, and appeals that have been heard in the past year, the subject of

the reconsideration, review or appeal (e.g. selection, assessment, training time, specialist international medical

graduate assessment) and the outcome (number upheld, number dismissed)

The RACS Appeals Mechanism is currently under review to streamline the process to provide greater clarity.

During this period of review, there is inadequate data for accurate reporting. See response to Condition 3.

Table 1 Requests for reconsideration

Reason for Reconsideration Number of

reconsiderations

Outcome

Upheld Dismissed

Insufficient data to report



5

Table 2 Requests for review

Reason for Review Number of

reconsiderations

Outcome

Upheld Dismissed

Insufficient data to report

Table 3 Requests for appeal

Reason for Appeal Number of

reconsiderations

Outcome

Upheld Dismissed

Appeal against the decision to dismiss trainee from the Neurosurgery SET program.

1 1

Appeal against the decision to dismiss trainee from the Urology SET program

1 1

Appeal against an IMG assessment of ‘not comparable’ to an Australian or New Zealand trained Urologist

1 1

Governance Policies/Procedures

Changes to the following documents since the last progress report, can the changes be described in the table

below and the updated documentation attached to this progress report.

Table 4 RACS governance (policies and procedures)

Policies/Procedure Description of Changes

College Governance Chart Organisational restructure in progress (Appendix 1)

Conflict of Interest No change

Standard 2: The outcomes of specialist training and education


6


Areas covered by this standard: educational purpose of the educational provider; and, program and graduate

outcomes


A high level business plan has been developed – the Education Program of Work 2018-2020 (Appendix 3) –

to provide focus for the educational outcomes to be achieved by 2020. The plan defines ten broad areas of

work, and the interdependent projects should ensure excellence for the Surgical Education and Training (SET)

program, incorporating RACS strategic drivers e.g. the Building Respect and Improving Patient Safety Action

Plan, and the conditions required for ongoing accreditation by the AMC and MCNZ.

The focus of the plan is to enhance and implement program improvements across the continuum of training

and education. This has been commended by the speciality training boards and specialty societies. Further

details can be found in the plan.


BB Benchmark the graduate outcomes of each of the surgical training programs internationally.

In collaboration with the speciality training board, work on better defining the graduate outcomes of each of

the surgical training will be progressed.

As part of the AOA21 project, the orthopaedic training program was benchmarked globally such that the project

will be/is best educational practice.

CC Improve the uniformity of presentation of training program requirements and graduate outcomes for each of the surgical specialties (particularly on the website), taking into account feedback from trainees, supervisors and key stakeholder groups


DD In conjunction with the specialty training boards, review and report on the reasons for the pervasiveness of post-fellowship training and any potential impact on the appropriateness of the Surgical Education and Training (SET) program.

The pervasiveness of post-fellowship training remains a topic of discussion and ongoing review by specialty

training boards. The approach differs between specialities as a result of differing requirements and identified

gaps; there is a range of opinions. Post-fellowship training is a deep concern to trainees and is often raised

in discussion and through the bi-annual RACS Trainees’ Association (RACSTA) trainee survey.

Comments from several specialty training boards have indicated:

the value in additional structured experience to broaden and deepen training outcomes;

Suitable post-fellowship training may be within ANZ or overseas;

the need for ongoing monitoring of the impact of local fellowship posts on SET trainees;



7

the need to consider incorporation of training in new technologies into training that may be obtained in

post-fellowship years.


Condition 5 Define how the College’s educational purpose connects to its community responsibilities.

To be met by: 2020

Work defining RACS’ educational purpose is being conducted in association with defining graduate outcomes

and is linked to Conditions 6, 7, 8, 9 and 14. The scope of this work incorporates increased focus on community

expectations and feedback to RACS.

It is noted that RACS’ responsibilities to its community are woven into the fabric of the Building Respect and

Improving Patient Safety and the Diversity and Inclusion plans.

RACS has convened a series of Rural Surgical Training workshops to identify integrated training pathways in

order to address deficiencies in rural surgical services. A key aim is to define and implement a set of strategies

that will help select, train and sustain a surgical workforce responsive to the specific needs of regional and

rural Australia. This work is being undertaken in collaboration with all State and Territory jurisdictions and with

the involvement of the specialty training boards, specialty societies and RACSTA.

Condition 6 Broaden consultation with consumer, community, surgical and non-surgical medical, nursing and allied health stakeholders about the goals and objectives of surgical training, including a broad approach to external representation across the College.

To be met by: 2021

Each speciality training board has appointed an external community representative. Early indications from the

speciality training boards are that these new roles are highly regarded and a valuable addition to the boards’

discussions and decision making.

Strategies to broaden consultation with non-surgical stakeholders will be incorporated into the project being

undertaken to articulate program and graduate outcomes (Refer to Conditions 5, 7, 8 and 14)

RACS has met with the National Rural Health Commissioner and is also collaborating with the Australian

College of Rural and Remote Medicine, the Royal Australian College of General Practitioners and the Rural

Doctors Association of Australia to support training of procedural rural general practitioners.



8

Condition 7 Clearly and uniformly articulate program and graduate outcomes (for all specialties) which are publicly available reflect community needs and which map to the nine RACS competencies.

To be met by: 2021

Defining and clearly articulating the program and graduate outcomes underpins the educational development

of curricula, assessment and professional development and impacts on current and planned work as described

in the Education Program of Works and this document.

It is noted that currently several boards are undertaking curriculum reviews or implementing work based

assessments that more clearly identify the expected graduate outcomes. Cardiothoracic, General Surgery,

Neurosurgery, Otolaryngology Head and Neck Surgery, Plastic and Reconstructive Surgery (Au and NZ) and

Urology are well underway with this activity. Outcomes for Orthopaedic Surgery have been defined within the

AOA 21 curriculum

(Refer Standard 3; Conditions 5, 6, and 14)


Nil required.

Standard 3: The specialist medical training and education framework


9


Areas covered by this standard: curriculum framework; curriculum content; continuum of training, education

and practice, and curriculum structure.


All speciality training boards report their support for competency-based curricula and most have provided

details of the curricula (refer Condition 12 and Condition 13 commentary. Also see Appendix 10).


EE Develop explicit criteria to consider whether training periods of less than the standard six months can be approved, and ensure that prior learning, time and competencies acquired in non-accredited training are fairly evaluated as to whether they may count towards training.

Several specialty training boards are moving towards accepting fewer than 20 weeks per six-month (26-week)

term being recognised as contributing to training. The recommendation aligns to the progress towards

implementing flexible training options (See responses to Condition 13 and Appendix 10, Specialty Responses).

For Surgical Education and Training (SET) applicants, experiences in non-accredited posts contribute to

achievement of selection pre-requisites and activities scored in CVs. Specific experience acquired in non-

accredited positions is not counted towards time in training by all specialities, however, the competencies so

acquired may be recognised as the trainee is assessed and progresses within the competency-based training

program. Paediatric Surgery and Urology recognise prior learning and trainees can commence in SET 2 or 3.

General Surgery regulations allow for recognition of prior learning for trainees who have been on the training

program previously. General Surgery is also reviewing flexible training options for trainees who only complete

2-3 months of a term.

FF Make available to all trainees the learning modules under the Building Respect, Improving Patient Safety (BRIPS) program, once most or all College Fellows are trained

As the mandatory training for supervisors, trainers and senior committee members nears full compliance, the

Foundation Skills for Surgical Educators course (FSSE) is being made available to trainees.

The speciality training boards have indicated their active encouragement and support for trainees to complete

the FSSE and the Operating with Respect e-learning modules, and Urology has mandated the FSSE for SET

6 (final year) trainees. A dedicated FSSE course for Urology senior trainees was held in 2017 and another is

planned for 2018. Senior Vascular Surgery trainees are also attending a dedicated FSSE course. The intention

is to also develop a trainee-specific OWR face to face course with RACS Trainees’ Association (RACSTA)

involvement.


Condition 8 Enhance and align the non-technical competencies across all surgical specialties, including a consideration of the broader patient context.

To be met by: 2021

Linked to development of generic curriculum and work under Conditions 6,7,8,9 and 14.



10

Condition 9 As it applies to the specialty training program, expand the curricula to ensure trainees contribute to the effectiveness and efficiency of the healthcare system, through knowledge and understanding of the issues associated with the delivery of safe, high-quality and cost-effective health care across a range of settings within the Australian and/or New Zealand health systems.

To be met by: 2021

Aligned to the development of a generic curriculum (see Condition 8).

RACS recognises that understanding the healthcare system covers the issues mentioned and that some

medical schools (e.g. Monash) have dedicated subjects within their medical degrees, and such knowledge

already gained will be built upon.

Condition 10 Document the management of peri-operative medical conditions and complications in the curricula of all specialty training programs.

To be met by: 2021

Progress

The management of peri-operative medical conditions and complications is included in the General surgery

SEAM modules, and the curricula of the Neurosurgery, Orthopaedic and Plastic and Reconstructive Surgery

(Au) and Otolaryngology Head and Neck Surgery training programs.

Peri-operative management will be explicitly included in the revision of the curriculum for Urology and Plastic

and Reconstructive (NZ), both currently in development.

Condition 11 Include the specific health needs of Aboriginal and Torres Strait Islanders and/or Māori, along with cultural competence training, in the curricula of all specialty training programs.

To be met by: 2021

Dr David Murray, Chair Indigenous Health Committee, Mr Pat Alley, Chair Māori Health Advisory Group and

Professor Martin Nakata, Education Advisor attended the Board of Surgical Education and Training (BSET)

meeting in February 2018 to offer support and advice to the specialty training boards. The Chair of BSET

requested all specialty training boards to share curricula information with Professor Nakata to enable the

Indigenous Health Committee to provide guidance and advice regarding inclusion of cultural awareness

training. Specialty information is currently being gathered. In New Zealand a hui (meeting) is being convened

with speciality training board representatives to discuss the specific elements related to Māori health.

A funding proposal to develop cultural awareness training has been submitted to the Federal Government

under their Specialist Training Program (STP) initiative. Work will commence on developing generic modules

to upskill participants on cultural competence.

Condition 12 In conjunction with the specialty training boards, develop a standard definition across all training programs of ‘competency-based training’, and how ‘time in training’ and number of procedures required complement specific observations of satisfactory performance in determining ‘competency’.

To be met by: 2020

Progress in competency-based training has been made by specialty training boards as they revise curricula.

Increasingly curricula define outcomes and competencies linked to stages of training which are bound by

flexible time periods. Some training boards are using behavioural markers to describe a standard of



11

performance and increasingly, work based assessments are used to determine performance against

standards.

General Surgery has approved a move to competency-based training which includes Entrustable Professional

Activities (EPA) and Procedure Based Assessments (PBA) and other work based assessments combined with

timeframes. Orthopaedic Surgery has adopted a modular approach to progression through training and has

introduced ‘stages’ of training with minimum and maximum completion timeframes; accredited time is no longer

used. Work-based assessments progress towards early consultant practice level. Otolaryngology Head and

Neck Surgery have similarly introduced three competency-based levels of training with minimum and maximum

completion timeframes and progression largely defined by work-based assessment. Behavioural markers

describe standards of performance in each stage. Neurosurgery and Paediatric Surgery implemented

competency-based curricula several years ago. Plastic and Reconstructive Surgery (Au) has introduced

milestones for trainees which articulate the level of competence to be achieved and monitor progress through

the program and Urology and Plastic and Reconstructive Surgery (NZ) will incorporate measures to assess

competency in their revised curricula. In the Vascular Surgery curriculum, work based assessment is based

on seven competencies. Standards are identified for each competency at each set level. Cardiothoracic

Surgery supports competency-based training,

Condition 13 RACS has a policy that is applicable to all specialty training programs to remove the overt and hidden barriers to flexible forms of training. RACS must build on the existing policy and processes, and liaise with hospitals to implement flexible training.

To be met by: 2018

RACS has contacted all training hospitals to determine if the hospital can offer flexibility and to identify specific

training posts in the hospital that could be other than full time. Of the 162 hospitals contacted, 118 (73%)

indicated their ability to offer flexible positions, 24 (15%) were unable to do so and responses were not received

from 20 (12%). See Appendix 4 for the breakdown of responses by region and speciality.

The hospital responses have been circulated to the speciality training boards. In parallel, some individual

boards have made contact with their training units to determine if and where flexible posts can be identified.

Neurosurgery, Orthopaedics Surgery (Au and NZ), Paediatric Surgery, Plastic and Reconstructive Surgery (Au

and NZ) and Urology have done so. General Surgery and Otolaryngology Head and Neck Surgery NZ have

included flexible training as a component of hospital accreditation.

An encouraging cultural change is evidenced by the discussions over several meetings of the Board of Surgical

Education and Training, and RACSTA have advocated strongly and effectively to BSET. At the June 2018

meeting of BSET, each specialty training board outlined their progress, reporting on new flexible posts

identified for 2019 and discussing the processes and requirements to establish flexible posts. Flexible training

continues to be a standing item on each BSET meeting agenda.

Approaches to flexible training differ between specialties, in part due to differences between numbers of

trainees and training posts per specialty, flexible training has been embraced by all speciality training boards.

This has been reflected in their regulations and post accreditation standards e.g. AOA 2019 training

regulations stipulate that training sites with 3 or more posts must make a part-time position available; Paedatric

Surgery states that if a hospital has more than 2 training posts, one post must be available as a flexible option.

The intent is to normalise flexible training as an option for trainees but it is recognised that iterative

development is required. The success of the measures taken to date will be identified in 2019 when the flexible

posts identified this year are utilised.


Nil required.

Standard 4: Teaching and learning approach and methods


12



As speciality curricula are revised and developed, new methods of work based assessment, use of simulation

and the private sector have offered alternative opportunities for learning.


GG Consider options to mitigate the lack of training in some parts of Australia and New Zealand, such as in outpatient settings, endoscopy and aesthetic surgery

To mitigate the lack of access to outpatients, endoscopy and aesthetic surgery, Orthopaedic, General Surgery

and Plastic and Reconstructive Surgery training boards are considering utilising private consulting rooms and

working with hospitals to ensure alternative arrangements are in place, via training post accreditation criteria.

General Surgery is also proposing an accreditation standard for all new post applications whereby the new

post must have access to outpatients.

Limited access to endoscopy and colonoscopy is being managed through the introduction of new procedure-

based assessments (PBAs) to support training in this area and consideration of introducing basic endoscopy

training for trainees in New Zealand to encourage accredited hospitals willingness to allow trainee access to

endoscopy suites.


Condition 14 For all specialty training programs, develop curriculum maps to show the alignment of learning activities and compulsory requirements with the outcomes at each stage of training and with the graduate outcomes. This could be undertaken in conjunction with the curricular reviews that are currently planned or underway.

To be met by: 2021

Some speciality training boards have progressed the alignment of learning activities and required outcomes

at each stage of training and this work aligns to Conditions 5, 6,7,8, and 9.

General Surgery and Urology have indicated that as curricula are developed or revised, defined levels of

progression to required standards or outcomes will be mapped. Orthopaedic Surgery and Otolaryngology

Head and Neck Surgery have curricular frameworks that outline expectation of performance at each stage of

learning; learning opportunities have been broadly mapped to the curriculum competencies. There is a

comprehensive curriculum map in place for Cardiothoracic Surgery.


Nil required.

Standard 5: Assessment of learning


13


Areas covered by this standard: assessment approach; assessment methods; performance feedback;

assessment quality


Improvements to the conduct of the Fellowship Examination (FEX) have been implemented in response to

feedback received from fellows and candidates.

In April 2018, a workshop for senior examiners was conducted to improve the quality and relevance of the

written feedback reports provided to failing candidates and their supervisors post FEX. The emphasis of the

workshop was to upskill the senior examiners in writing feedback that is specific and useful in assisting

candidates and supervisors to understand and identify areas for improvement. The new approach to writing

feedback reports was implemented in May. Once distributed, the examiners’ reports were reviewed by the

RACS Principle Educator and feedback will be provided to the examiners to continue to improve their skill and

the overall process.


JJ For all surgical specialties, adopt behaviour-related reporting (i.e. descriptive of the key features) rather than simple scoring for all work-based assessments.

See Standard 4 for information regarding specialty implementation of work-based assessments.

KK Explore the use of multi-source feedback for all surgical training programs at set points throughout training.

IMGs on pathway to fellowship across all specialties participate in 6-monthly multi source feedback (MSF).

Cardiothoracic Surgery, Orthopaedic Surgery, Paediatric Surgery and Urology are using MSF or 360o

evaluation. Most MSF/360o evaluations are used for trainees in difficulty or for SET1 trainees, rather than

routinely at this stage. Cardiothoracic Surgery has introduced two 360o evaluations for SET1 trainees.

LL Review whether the term ‘essay-type’ is appropriately used in all its current contexts. Where essay-type questions are used, consideration should be given as to whether they could be replaced with short-answer type questions.

Refer response to Condition 15.


Condition 15 Respond to the 2016 Review of Assessments Report by Cassandra Wannan by noting whether recommendations have already been implemented, require implementation or are rejected, including a rationale for the latter.

To be met by: 2018

The recommendations contained in the Review of Assessments report have been reviewed and considered

by the speciality training boards, Court of Examiners and Surgical Science and Clinical Examinations

Committee. None of the recommendations has been rejected outright. Some have been implemented and

some are yet to be implemented.



14

In regard to the examinations, six of the seven recommendations are in stages of implementation or have been

completed. Recommendation 6, suggesting the use of alternatives to essay questions, will be considered as

the electronic format for the FEX written paper is developed.

Following the release of the Review of Assessments report, a number of specialties have taken steps to update

their work-based assessment (WBA) processes to ensure that they are aligned with current evidence-based

best practice.

General Surgery is moving to toward entrustable professional activities (EPAs) and procedure-based

assessments (PBAs); Otolaryngology Head and Neck Surgery has introduced procedure-based assessments

(PBAs) is considering entrustable professional activities (EPAs). A number of other specialties have made

changes to their assessment processes and forms to better reflect levels of competence required at specific

stages of training.

Most specialties have implemented, or are considering, assessment structures in which specific procedures

that are required at any given stages of training are clearly defined, and progress toward achieving competency

in these procedures is monitored.

The uptake of multi-source feedback (MSF) as an assessment tool remains limited. However, as noted above,

some specialties have utilised MSF as an additional assessment tool for trainees in difficulty.

In summary:

Cardiothoracic and Otolaryngology, Head and Neck Surgery have indicated interest to further develop

WBA practices in collaboration with the RACS education department staff.

General Surgery is moving towards PBAs

Otolaryngology, Head and Neck Surgery is using PBAs

General Surgery is moving towards EPAs

Plastic and Reconstructive Surgery and Urology are using EPAs

Urology, Orthopaedic, Paediatric and, Cardiothoracic Surgery are using MSF/360o evaluation, mostly in

the early stage of training or for trainees in difficulty

Plastic and Reconstructive has explicitly addressed all recommendations pertaining to WBA.

Plastic and Reconstructive, Otolaryngology, Head and Neck Surgery and Urology are using DOPS and

MiniCEX.

Orthopaedic Surgery (Au), Otolaryngology, Head and Neck, Paediatric and Vascular Surgery have defined

competencies for stages of training.

(See Appendix 10 detail)

Condition 16 Implement appropriate standard setting methods for all specialty-specific examinations (The AMC recognises that at least three specialties are already compliant in this respect).

To be met by: 2019

The following specialty specific examinations have predetermined pass scores and construct exams

accordingly. Work is in progress with these specialties to review their methodologies and increase

accountability:

Cardiothoracic Surgical Sciences and Principles Examination (CSSP)

Plastic and Reconstructive Surgical Sciences and Principles (PRSSP)

Orthopaedic Principles and Basic Sciences (OPBS)



15

Paediatric Anatomy and Embryology Examination (PAE) and the Paediatric Pathophysiology Examination

(PPE).

Urology Surgical Sciences Examination

Otolaryngology, Head and Neck and Vascular Surgery use a modified Angoff method, facilitated by RACS

staff, to standard set their specialty surgical sciences examinations. General surgery also uses a modified

Angoff method for standard setting assessments within the 8 SEAM modules


Summative assessment activity for the Surgical Sciences, Clinical and Fellowship examinations. The number

and percentage of candidates sitting and passing each time they were held

Table 5 Examination pass rates

Examination Activity Candidates sitting

examination

Candidates passed

examination

% of candidates passed

examination

Generic Surgical Science Examination

31 16 51.6%

Specialty Specific Surgical Sciences Examination

191 162 84.8%

Clinical Examination 275 218 79.3%

Fellowship Examination – all attempts*

327 207 63.3%

Fellowship Examination – annual pass rate#

271 207 76.4%

Fellowship Examination – SET trainees

282 192 65.4%

Fellowship Examination – IMGs 45 15 33.3%

* Total sittings: records numbers of candidates; some candidates sit twice during a year.

# Annual pass rate reports on the success rate of the individual candidates (over 1 or 2 sittings) passing

Fellowship Exam in 2017.

Standard 6: Monitoring and evaluation


16


Areas covered by this standard: program monitoring; evaluation; feedback, reporting and action


Evaluation of the Building Respect and Improving Patient Safety and the Diversity and Inclusion plans are

ongoing. Feedback leading to evaluation and monitoring of the Surgical Education and Training (SET)

program will be a focus of RACS’ management and speciality training boards in 2019.


MM Explore with trainees how response rates to surveys on training posts could be improved.


NN Implement the planned New Fellows’ Survey to evaluate their preparedness to practise and the annual survey of trainees who leave surgery without completing the program.

An initial Younger Fellows survey was distributed to all Younger Fellows (Fellows in their first 10 years of

practice) in March 2018. A presentation on the preparedness for practice and alignment for workforce was

delivered in May 2018 at RACS ASC, Sydney.


Condition 17 Develop an overarching framework for monitoring and evaluation, which includes all training and educational processes, as well as program and graduate outcomes.

To be met by: 2019

RACS’ management and speciality training boards collect data from a variety of sources across the breadth

of the training program; reports and formats differ. Collated data informatics into standard reports will underpin

the development of an overarching framework for monitoring and evaluation. Quarterly overall SET program

data is reviewed, providing more dynamic information similar to the 2014 SET evaluation and subsequent

2015-17 data.

At present, Orthopaedic Surgery has a monitoring and evaluation framework in place, and General Surgery is

planning to introduce a comprehensive evaluation process.

Condition 18 In conjunction with the specialty training boards, develop a policy to manage the situation whereby a trainee has been inadvertently identified as a result of providing feedback.

To be met by: 2018

RACS continues to foster learning environments in which trainees are safe and confident to provide feedback

or to complain. The Building Respect and Improving Patient Safety Action Plan is designed to promote safe

training environments and to implement cultural change, and it is acknowledged that these goals may be

generational. To this end and as part of the Building Respect and Improving Patient Safety Action Plan,

considerable work has been undertaken to improve and build confidence in the complaints and reporting

process. Following an external review of the process (refer Standard 1: Summary of significant developments),

a recommendation to develop a disclosure statement on victimisation has been actioned. The disclosure



17

statement makes explicit that RACS will not tolerate victimisation. Processes are in place to support the

confidentiality of trainees, and the speciality training boards are highly cognisant of the need for confidentiality.

Against this background, the discussion paper “Responding to and supporting trainees who provide feedback”

describes seven principles for responding to and supporting a trainee who may feel disadvantaged or

vulnerable after providing feedback, or lodging a complaint. These principles were accepted and approved by

the Board of Surgical Education and Training in June 2018 as a basis for a contingency plan to address the

situation whereby a trainee has been inadvertently identified as a result of providing feedback.

The principles will be published on the RACS webpage – About Respect – and circulated to trainees via RACS

Trainees’ Association and the speciality training boards. See Appendix 5 “Responding to and supporting

trainees who provide feedback”

Condition 19 Establish methods to seek confidential feedback from supervisors of training, across the surgical specialties, to contribute to the monitoring and development of the training program.

To be met by: 2019

Currently, the main channel to receive feedback from supervisors is via direct communication to the relevant

specialty training board, or training board chair. Supervisors are represented on all training boards. Supervisor

feedback is received during training post accreditation.

Neurosurgery has introduced bi-annual supervisors’ meetings which have resulted in significant input by

supervisors into the structure and management of the training program and assessment tools. Similarly, the

Vascular Surgery Training Board conducts two meetings per year, specifically to seek supervisor feedback.

The AOA Federal Training Committee routinely seeks feedback twice annually, and at other events e.g. ‘Bone

Camp’, trial exams.

Linked to Condition 17.

Condition 20 Develop and implement completely confidential and safe processes for obtaining—and acting on—regular, systematic feedback from trainees on the quality of supervision, training and clinical experience.

To be met by: 2019

The RACS Trainees’ Association (RACSTA) Survey, conducted six-monthly is proving to be a valuable source

of information on aspects of training, including the quality of supervision and training and clinical experience.

A variety of processes for obtaining trainee feedback has been reported. The trainee representative on each

specialty training board is the usual conduit for receiving regular, systemic feedback from trainees. General

Surgery and Urology have regulated for feedback on training posts as a component of training post

accreditation. Neurosurgery, Orthopaedic Surgery, Otolaryngology Head and Neck Surgery, Plastic and

Reconstructive Surgery (Au), and Urology have reported routinely seeking feedback from trainees. Plastic

and Reconstructive Surgery (NZ) conduct an annual trainee survey to gather trainees’ feedback.

These and other methods to obtain and act upon systemic feedback will be a considered in the development

of an evaluation framework (Condition 17).



18

Condition 21 Develop formal consultation methods and regularly collect feedback on the surgical training program from non-surgical health professionals, healthcare administrators, and consumer and community representatives.

To be met by: 2020

To date, the Cardiothoracic Surgery and Urology training boards are the only boards reporting that feedback

from non-surgical health professionals and health care administrators is sought. This occurs during training

post accreditation.

Condition 22 Report the results of monitoring and evaluation through governance and administrative structures, and to external stakeholders. It will be important to ensure that results are made available to all those who provided feedback.

To be met by: 2020

As indicated in Condition 20, the RACSTA Trainee Survey is a major source of trainee feedback on multiple

aspects affecting learning environments and trainee wellbeing.

The survey is reported to and discussed by the Board of Surgical Education and Training and the Education

Board. The major survey findings are communicated to trainees via RACSTA.

RACS produces an annual Activities Report and the RACS Annual Report. Both are publicly available and

the Annual Report is circulated to major stakeholders.

Condition 23 Develop and implement an action plan in response to the 2016 Leaving Surgical Training study. To be met by: 2019

An editorial and article have been published in the ANZ Journal of Surgery exploring the themes presented in

the Leaving Training Report, and as precursor to further response to the report:

Truskett P., 2018 Soil, Seed or the tiller: why do trainees leave? (Appendix 6)

Forel D., Vandepeer M., Duncan J., Tivey D.R., and Tobin S.A., 2018 Leaving surgical training: some of the

reasons are in surgery (Appendix 6)

Within separate research, focus groups were held to explore the barriers to a career in surgery, with particular

emphasis on women’s opinions regarding what might prevent them choosing surgery. Based on the report

from the focus groups, a broad survey will be undertaken to further investigate the barriers to entering and

continuing in surgical training. Such information will inform RACS responses, including promotion of surgery

as a career.



19


A summary of evaluations undertaken and the main issues arising from evaluations. RACS’ response to issues

raised, including how RACS reports back to stakeholders.

Table 6 Evaluation of activities

Evaluation activity Instigated by Issues arising College response to issues

Annual selection review reports for specialty training (2018 intake)

RACS Identified poor discrimination and possible bias in the Referee Report selection tool. Identified poor discrimination in the Referee Report selection tool.

Annual selection review reports for specialty training boards included a section outlining concerns identified with regards to the Referee Report which may result in bias in selection. Concerns regarding Referee Report selection bias were raised in RACS publications: Surgical News (April 2017 Pg. 10, featured article: “SET Selection Referee Reports” Appendix 7)

Skills courses for SET trainees (ASSET, CCrISP, CLEAR, EMST and TIPS) curriculum review and development

PSEC Blended learning requirements (online and face-to-face) required review and redevelopment of course curriculum.

Skills course faculty presented with participant feedback reports for quality improvement, revised course curriculum and developed online/pre-course learning modules.

Attrition from SET review

RACS Internal reports of data regarding trainees who leave SET were affected by varying definitions of withdrawal, attrition and dismissal, and complicated by the RACS’ database management system.

Quarterly reports were developed for improved presentation of valid estimates of attrition for senior stakeholders.

Trainees’ Association (RACSTA) survey evaluation

RACSTA Main issues arising from the 5-year review included existence of discrimination, bullying and sexual harassment.

Report prepared for BSET, RACS continued to advocate BRIPS, mandating all Fellows, trainees and IMGs to complete the online module

Clinical and Generic Surgical Science Exam feedback reports

RACS GSSE Exam Committee

Trainees who fail the Clinical or Generic Surgical Science Exams are at risk of being dismissed from the program. Letters of feedback for unsuccessful trainees provided limited information on what areas of their performance they need to focus on to improve their performance on future sittings.

Trainees who fail either exam are provided with improved feedback from to identify areas in their clinical and non-clinical skills and medical knowledge that require improvement. Feedback can now be used to help supervisors guide trainees on their learning goals within the rotation, with respect to identified areas for improvement.

https://www.surgeons.org/policies-publications/publications/surgical-news/surgical-news-archive/



20

Evaluation activity Instigated by Issues arising College response to issues

RACS examinations standard setting

RACS GSSE Exam Committee

Consolidation of RACS examinations required review of the statistical programs and scripts to ensure consistency in the standard setting approach across exams and quality assurance.

RACS development of a GIT repository to store and version control RACS examination statistical code and procedures.

Standard 7: Issues relating to trainees


21


Areas covered by this standard: admission policy and selection; trainee participation in education provider

governance; communication with trainees; trainee wellbeing; resolution of training problems and disputes


A selection workshop, with representation from all specialities was conducted in April. The attendees heard

presentations from RACS staff and international experts, and were able to consider and discuss the concepts

presented during breakout sessions. Key outcomes of this meeting were reported to the Board of Surgical

Education and Training (BSET) in June 2018. There was agreement to consider modifying existing selection

tools, developing and trialling situational judgement tests (SJTs) in selection and to conducting more robust

interviewer training. Interest in the link between number of attempts in selection and outcomes of training was

expressed by a number of the attendees. Discussions continue with the specialty training boards about

development of selection processes, the performance of current selection tools, and exploring the introduction

of new tools.

As a result of the workshop, a pilot Selection Interviewer Training Workshop was held in June 2018, prior to

conducting selection interviews. The Otolaryngology Head and Neck Training Board worked closely with

RACS staff and an external consultant to develop and deliver the pilot. The report on the pilot will be presented

at BSET in October with the expectation that there will be wider uptake prior to the 2019 selection process.

In June, the specialty training boards reported on their progress with the Aboriginal and Torres Strait Islander

Selection Initiative and were asked to identify suitable representatives to meet with Prof Martin Nakata to share

details of their curriculum to help support surgical training as well as the prevocational space. This work only

applies to Australia.


OO In relation to selection into the surgical training programs: (i) Evaluate the objectives of the selection process to ensure they are both clear and

consistent across all surgical training programs. (ii) Develop a process to ensure that updates and changes to entry prerequisites

undergo a consultation process, and provide appropriate lead time for prospective applicants to meet them.

(iii) Explore the means by which prevocational work performance and technical ability may be more appropriately assessed as part of the selection process.

Examine the key discriminators (e.g. academic record, research, experience, interview performance) in the current selection process and whether these are the most relevant for predicting performance both as a trainee and as specialist

Many of the sub-recommendations were discussed at the 2018 Selection Workshop, which reviewed a range

of evidence-based best-practice processes in selection for surgical training. As referred to above, workshops

with specialty training boards to further develop best-practice selection tools are being planned for the next 12

months.



22

PP Implement a program to increase awareness of the presence and role of the RACS Trainees’ Association (RACSTA).

No new initiatives have been introduced. The response rate to the RACSTA Trainee Survey and direct contact

with RACSTA board members are the indicators of RACSTA’s relevance and profile. RACSTA representatives

sit on all major RACS educational and training boards and committees and RACSTA input is sought for all

multiple key educational activities and initiatives. The current indicators show growing engagement.


Condition 24 Further develop the selection policies for each surgical training program, particularly with regard to the provision of transparent scoring of each element in the curriculum vitae and the standardisation in the structure of referee reports. To be met by: 2020

Following the Selection Workshop and through the Board of Surgical Education and Training, all the speciality

training boards are reviewing selection practices, including the role and relevance of the CV and referee

reports. Considered trial of SJTs by some Boards to evaluate behavioural attributes, and establishing training

and standards for interview processes is accepted as important. Concepts of diversity amongst interviewers

and containment of unconscious bias were part of the recent piloted interviewer training (see also condition

27)

Annually the selection regulations are reviewed by the Board of Surgical Education and Training.

Condition 25 Clearly document and make publicly available the standard of entry into each surgical training program. To be met by: 2018

The standard of entry is stated and publicly available in speciality selection regulations as follows:

Table 7 Specialty standards of entry into SET

Surgical Specialty Selection regulation regarding standard of entry

Cardiothoracic Surgery The minimum standard for selection into the SET Program in Cardiothoracic Surgery is an overall combined and adjusted score of at least 65% in the three (3) selection tools (Item 4.8 Selection Regulations 2018).

General Surgery (Australia) To satisfy the minimum standard for selection, applicants must rank above the fourth quartile (i.e. within the top 75% of ranked applicants). These applicants will be considered suitable for selection (Item 3.2.2 Selection Regulations 2018).

General Surgery (New Zealand) To satisfy the minimum standard for selection; candidates must achieve a combined score of 53 out of 75 combined scores for Curriculum Vitae and Referee Report. Applicants who meet this standard will be offered an interview. All other applicants who do not meet these minimum standards will be deemed unsuitable and informed of the decision (Item 5.5.3 Selection Regulations for 2019 Intake).

Neurosurgery Applicants who satisfy the standard in Regulation 5.7 will be ranked according to their combined score for the Structured Curriculum



23


Vitae, Neurosurgery Anatomy Examination and Reference Report (which equates to a score out of 75 points). All other applicants will be deemed unsuitable and will not proceed further in the selection process (Item 5.8 Selection Regulations 2018).

Orthopaedic Surgery (Australia) AOA Selection Regulations do not define a minimum standard of entry beyond eligibility to apply (which requires completion of at least 26 working weeks of orthopaedic surgical experience within the last two years, successful completion of the GSSE and a state-licenced radiation safety course).

Applicants are ranked based on a combined score (CV 25% + Referee scores 75%), and invited to interview based on the number of expected posts available in the following year.

Applicants not invited to interview will not be considered for selection.

Orthopaedic Surgery (New Zealand)

To receive an interview, Applicants must achieve a combined adjusted score of 30/50 on the Curriculum Vitae and Referee Report. Applicants who achieve this minimum standard will receive an interview. Applicants who do not satisfy these minimum standards will not be eligible for an interview and will be advised accordingly. The Regulations are currently under review for 2019 and this will change. All changes will be published in the Regulations in November 2018. (Item 7.2 Selection Regulations 2018).

Otolaryngology Head and Neck (Australia)

Applicants who attend the Semi-Structured Otolaryngology Head and Neck Surgery Panel Interview must achieve a weighted interview score of 28/40 or greater to meet the minimum standard for selection (Item 5.5.1 Selection Regulations 2018).

Otolaryngology Head and Neck (New Zealand)

Applicants who attend the semi-structured panel interviews must achieve a weighted interview score of 28/40 or greater to meet the minimum standard for selection (Item 5.3.4 Selection Regulations 2018).

Paediatric Surgery The minimum standard score needed to be appointed to Paediatric Surgery training is 72%. Applicants who do not achieve a combined score of 72% or above will be deemed unsuitable for training and therefore unsuccessful in the selection process (Item 4.5 Selection Regulations 2018).

Plastic and Reconstructive Surgery (Australia)

Applicants who have proceeded through and achieved a minimum weighted score of 270 out of 450 points at interview for will be considered eligible for selection. Applicants who are considered eligible for selection interview will be ranked based on a composite score of all three selection tools. The maximum score possible in 2018 is 1000 points (Item 2.2.3 Selection Regulations 2018).

Plastic and Reconstructive Surgery (New Zealand)

The SET Selection requirements are publically available on the RACS website via the SET Selection Regulations and state eligibility requirements and the selection process (referee and candidate structured interviews).

Urology The minimum standard for selection will be the Overall Selection Score of the applicant whose ranking is 5 places below the number of available training positions (Item 7.9 Selection Regulations 2018).



24


Vascular Surgery Applicants who satisfy the minimum standards for selection and the eligibility conditions will be ranked. The ranking will be determined by applying weightings to the selection tools, providing an overall score out of 100, rounded to the nearest whole number (Item 7.2 Selection Regulations 2018). Applicants who attend the Semi-Structured Vascular Surgery Panel Interview must achieve a weighted interview score of 25/40 or greater to meet the minimum standard for selection (Selection Regulations to be published for 2020 intake.

Condition 26 Develop a policy that leads to the increased recruitment and selection of Aboriginal and Torres Strait Islander and/or Māori trainees in each surgical training program.

To be met by: 2019

After much dialogue, there has been a gradual and encouraging shift in cultural mindset to align with

contemporary community expectations. All specialty training boards support or endorse the RACS Aboriginal

and Torres Strait Islander Surgical Trainee Selection Initiative policy. RACS continues to promote the

importance of this initiative in a collaborative fashion.

The majority of specialty training boards have reserved positions in their training programs for candidates

(meeting standard of entry) who have self-identified as Aboriginal or Torres Strait Islander, or Māori. This

includes Cardiothoracic, General, Otolaryngology Head and Neck Surgery Paediatric Surgery, Urology,

Orthopaedic (Au) and Plastic and Reconstructive Surgery (Au).

The approach in New Zealand differs. Orthopaedic, Otolaryngology Head and Neck, Plastic and

Reconstructive and General Surgery support Māori doctors to have the knowledge, skills and experiences that

will assist them to gain entry to training and by giving recognition to knowledge of Māori tikanga in selection

scores. This is on the advice from several cultural advisors that this approach is culturally acceptable, where

an affirmative ‘selection pathway’ approach would not be.

The New Zealand Board of Plastic and Reconstructive Surgery (NZBPRS) has initiated dialogue with the New

Zealand Association of Plastic Surgeons (NZAPS) regarding a scholarship for Māori and Pacific Island Doctors

and medical students to attend the NZAPS Annual Scientific Meeting (ASM) to increase awareness of PRS as

a future career.

Condition 27 Promote and monitor the Diversity and Inclusion Plan through the College and specialty training boards to ensure there are no structural impediments to a diversity of applicants applying for, and selection into, all specialty training programs.

To be met by: 2019

As only gender and indigenous identification (self-reported) are recorded as part of the selection process,

these are the aspects of diversity currently monitored and reported. Significant progress has been made to

recruit and select indigenous candidates (refer to Condition 26 response).

Work continues to identify the barriers to medical students choosing a career in surgery and to understand the

reasons for female attrition from the training program. This work will inform the identification of any structural

impediments and will help to promote greater diversity in selection.

There is recognition for the need to identify and recognise “rurality” in applicants in order to promote surgical

training aligned to a rural pathway. General Surgery has indicated it will implement such an initiative.

Diversity and inclusion and containment of unconscious bias will be components of selection interviewer

training.



25

Monitoring of progress on the Diversity and Inclusion plan is ongoing

Condition 28 Increase transparency in setting and reviewing fees for training, assessments and training courses, while also seeking to contain the costs of training for trainees and specialist international medical graduates.

To be met by: 2019

Specialty training boards and RACS publicly advertise fees on their websites

Greater transparency in setting and reviewing fees will be a focus in 2019. It is noted that some progress has

been made, with Neurosurgery, Orthopaedic Surgery, Plastic and Reconstructive Surgery (Au) and Urology

reporting that costing exercises have been undertaken. These boards report that fees are set on a cost

recovery basis, and that trainees have been advised of the process.

Condition 29 Address trainee concerns about being able to raise issues and resolve disputes during training by ensuring there are mechanisms for trainees to do so without jeopardising their ongoing participation in the training program.

To be met by: 2019

Refer to responses for Condition 3 and 18



26


Additional annual performance data is available in the 2017 Activities Report (Appendix 8)

Trainees entering, completing and currently in training

The number of trainees, including Indigenous and Māori trainees entering the training program, including

basic and advanced training;

the number of trainees, including Indigenous and Māori trainees who completed training in each program;

and

the number and gender of trainees undertaking each college training program.

Table 8 Number of trainees entering training program

Training program ACT NSW NT QLD SA TAS VIC WA NZ O/S Total

Cardiothoracic Surgery

- 5 - - - - 2 - 1 - 8

General Surgery 3 27 2 22 4 - 25 6 15 1 105

Neurosurgery - - - 3 1 - 3 1 - - 8

Orthopaedic Surgery

- 15 - 11 3 - 16 1 10 - 56

Otolaryngology Head and Neck Surgery

- 7 - 6 4 - 3 1 4 - 25

Paediatric Surgery 1 2 - 1 - - - - - - 4

Plastic and Reconstructive Surgery

- 5 - 3 3 - 2 4 3 - 20

Urology 1 4 1 5 - - 9 - 2 - 22

Vascular Surgery - 1 - 1 2 - 1 1 2 - 8

Aboriginal and Torres Strait Islander and Māori trainees

https://www.surgeons.org/media/25670553/2018-05-09_rpt_activities_report_pdf_final.pdf



27

Table 9 Number of trainees completing training program

Training program ACT NSW NT QLD SA TAS VIC WA NZ O/S Total


- 2 - - - - - - 1 - 3

General Surgery 1 21 2 7 7 1 21 3 11 1 75

Neurosurgery - 2 - 2 - 1 3 - - 3 11

Orthopaedic Surgery

- 17 - 9 4 1 10 4 7 2 54


- 4 - 4 2 - 4 - 3 - 17

Paediatric Surgery - - - - - - 1 - - 1 2

Plastic and Reconstructive Surgery

- 2 - 2 2 - 6 - 2 2 16

Urology - 3 - 5 - 1 5 - 2 2 18

Vascular Surgery - 2 - 1 1 - 1 - - 1 6

Aboriginal and Torres Strait Islander and Māori trainees

Table 10 Number and gender of trainees undertaking each training program

Training program Male Female Unspecified Total

Cardiothoracic Surgery 33 8 - 41

General Surgery 279 155 - 434

Neurosurgery 36 12 - 48

Orthopaedic Surgery 250 33 - 283

Otolaryngology Head and Neck Surgery 58 28 - 86

Paediatric Surgery 14 17 - 31

Plastic and Reconstructive Surgery 69 30 - 99

Urology 77 25 - 102

Vascular Surgery 36 11 - 47



28

Selection into training

Changes to policies and/procedures

Policy / Procedure Description of changes

Selection in to training Specialty regulations are updated and approved by the Education Board annually (See attached summary table).

Standard 8: Implementing the program – delivery of education and accreditation of training sites


29

Standard 8: Implementing the program – delivery of education and accreditation of training

sites

Areas covered by this standard: supervisory and educational roles, and training sites and posts


The Foundation Skills for Surgical Educators (FSSE) and Operating with Respect (OWR) courses are intended

to equip surgical supervisors with skills in training, assessment, giving feedback, supporting trainees in

difficulty, addressing instances of unacceptable behaviour (‘speaking up’) and maintaining respectful work and

learning environments. These skills add to the provision of supports to supervisors. The speciality training

boards and specialty societies have worked extensively with RACS staff to communicate and encourage

compliance by supervisors and trainers, and this has been successful in achieving compliance of the

mandatory requirement to complete the FSSE and OWR.

Through advocacy and collaboration with the speciality training boards, specialty societies and government

jurisdictions, progress is being made towards expanding training into rural settings.


QQ Develop a policy that is adhered to by all specialty training boards which stipulates the minimum advanced notice required prior to requiring commencement of new rotations and which also minimises the number of interstate /international rotations.

Nothing to report.

RR Work with the jurisdictions to assist in preventing the loss of employment benefits when trainees transfer between jurisdictions.

Nothing to report.

SS Consider how to expand the surgical training programs in rural and regional locations.

Thirty-nine RACS training board and specialty representatives (from seven specialties) attended the first in a

series of Rural Training workshops in March 2018. The focus of discussion was how to ensure training was

fit for purpose to provide the community with surgeons capable, and with a desire to work in rural and regional

areas.

In June 2018 the President, RACS Councillors and the CEO met with Professor Paul Worley in his capacity

as National Rural Health Commissioner.

RACS is convening a summit of federal and state workforce jurisdictional representatives planned for 15th

September 2018 to drive improvements in recruiting and maintaining a rural and regional surgical specialist

workforce and in defining rural training pathways taking into consideration the specific needs of each State

and Territory. In addition, RACS is working closely with the Australian College of Rural and Remote Medicine,

the Royal Australian College of General Practitioners and the Rural Doctors Association of Australia including

providing review of the rural generalist pathways curricula for general practitioners.

TT Support collaboration amongst the specialty training boards to develop common accreditation processes and share relevant information.

Nothing to report.



30


Condition 30 Mandate cultural safety training for all supervisors, clinical trainers and assessors.

To be met by: 2020

Refer to response to Standard 3; Condition 11.

Condition 31 In conjunction with the specialty training boards, finalise the supervision standards and the process for reviewing supervisor performance and implement across all specialty training programs.

To be met by: 2021

The Standards for Supervision document was approved at the June meeting of the Board of Surgical Education

and Training (BSET).

The Surgical Supervisors Policy will be updated to include the Supervisor Responsibilities Matrix from the

Standards for Supervision document with a note to reflect that although the role definitions described for

Orthopaedic Surgery (Au) are different, the principles are agreed.

The new Advocacy Board will be consulted on how best to effectively articulate the standards and supporting

resources. See Appendix 9: Standards for Supervision document.

Condition 32 Promote the Building Respect, Improving Patient Safety program and encourage the positive participation of all fellows and trainees, including supporting all surgeons to “call out” bad behaviour in work and training.

To be met by: 2019

The mandated completion of the OWR eLearning module for all fellows, trainees and IMGs has achieved 95%

compliance as at 30 June 2018.

The training boards have affirmed their ongoing support for the Building Respect and Improving Patient Safety

Action Plan as evidenced by their active involvement and support of the RACS initiatives to ensure their

trainees, IMGs, supervisors, trainers complied with the mandatory requirements.

Table 11 SET and IMG supervisors’ and trainers’ completion of OWR and FSSE face-to-face course

Completed

exempt*/enrolled# Not Completed Total

OWR course

SET and IMG Supervisors 446 151 452

FSSE course

SET and IMG Supervisors 446 6 452

Trainers 2,331 154 2,485

Total FSSE course participants 2,777 160 2,937

Notes: *Exempt: have completed an equivalent course; #Enrolled: enrolled in course to delivered in 2018; OWR course:

trainers are exempt from attending this course.



31

Condition 33 In the hospital and training post accreditation standards for all surgical training programs include a requirement that sites demonstrate a commitment to Aboriginal and Torres Strait Islander and/or Māori cultural competence.

To be met by: 2019

A revision of the RACS standards for post accreditation will include reference to the requirement of Condition

33 will be undertaken next year.

It is noted that Plastic and Reconstructive Surgery and Neurosurgery have reported that changes are already

planned for post accreditation regulations to include specific reference for training sites to demonstrate a

commitment to Aboriginal, Torres Strait Islander and Māori cultural competence.


Accreditation activities including sites visited, sites / posts accredited or not accredited.

Table 12 Site accreditation activities

Number of Sites/Posts ACT QLD NSW NT SA TAS VIC WA NZ Total

Visited 2 31 30 5 18 7 60 16 51 220

Accredited 2 37 35 9 30 11 67 24 100 315

Not accredited 0 2 1 1 1 0 0 0 0 5

Standard 9: Continuing professional development, further training and remediation


32


Areas covered by this standard: continuing professional development; further training of individual specialists; remediation


The New Zealand Association of General Surgery (NZAGS) is developing a pilot program of practice visits which will attract CPD points for reflective practice. It is likely the pilot will be conducted in late 2018.

AOA is currently working towards addressing the recommendations of the Medical Board of Australia Framework within the AOA CPD Program.

AOA and RACS are partnering to pilot a practice visit program with senior Fellows, it is anticipated the pilot will commence in early 2019.

RACS is about to commence a comprehensive review of the RACS CPD Program, in line with the new MBA ‘Professional Performance Framework’. This will also involve the potential development of a new IT platform for CPD.


UU Implement a mechanism for the newly established CPD Audit Working Group to provide more robust feedback to Fellows, with a particular focus on the breadth of surgeons’ individual practice.

A surgical audit working party has been established to review standards for surgical audit both as a quality assurance activity and to define a minimum standard of audit for CPD compliance.

RACS has reported and published on the role of morbidity and mortality meetings.

VV As part of the reflective practice category consider including cultural competence as an area of reflection.

Participation in cultural competence activities has been included as an activity under Category 4 – Reflective Practice in the RACS CPD Program. RACS is also undertaking a review of the cultural competency education it provides, and is encouraging other education providers to have their activities approved within the RACS program.

WW Explore the College’s role in identifying the poorly performing fellow.

The surgical audit working party work and the morbidity/mortality papers will assist identification of poor clinical performance, be that at local hospital, network or specialty level. Work is ongoing to assist or remediate the poorly performing fellow.


There are no conditions for reporting.



33


The number and proportion of college fellows participating in and meeting the requirements of the college’s continuing professional development programs.

Table 13 Fellows participating in and meeting the RACS CPD program requirements

Number of Fellows Fellowship participating in CPD

Australia New

Zealand Other

Australia New Zealand Other

Total no. Total % Total no. Total % Total no. Total %

5179 820 348 16

Table 14 Non-fellows participating in and meeting the RACS CPD program requirements

Australia New Zealand Other

Total no. Total % Total no. Total % Total no. Total %

Standard 10: Assessment of specialist international medical graduates


34


Areas covered by this standard: assessment framework; assessment methods; assessment decision;

communication with specialist international medical graduate applicants


RACS has undertaken a number of new initiatives to provide greater support for specialist international medical graduate surgeons. RACS; Clinical Director of IMG Assessment and Support attended a Medical Board of Australia forum on Assessment of Specialist International Medical Graduates at which recommendations ensuing form the recent Deloitte Access Economics’ report and commence discussion about updating the MBA Good Practice Guidelines for IMG assessment.


XX Provide greater support for specialist’s international medical graduate surgeons working towards specialist/vocational registration, and including access to educational resources, such as examination revision course, and other resources that are accessible to trainees.

RACS has established an eLearning IMG Orientation Program. This program will benefit overseas trained

surgeons, who (potentially) become IMG surgeons under supervision by introducing them to the Australian

health care system, improving their knowledge and understanding of the best practice methods and by making

their transition to the Australian health care system and progression towards Fellowship as seamless as

possible

The five modules covered in the program are:

1. Australia and Health Care

2. Culturally Responsive Health Care

3. Aboriginal Health Care

4. Surgical Safety

5. RACS Specialist Pathway

From March 2018, IMGs who have accepted a specialist pathway must complete the RACS eLearning module

“IMG Orientation Program” prior to commencing clinical assessment.

RACS has also developed video resource regarding the clinical component of the Fellowship Examination

(FEX). The aim of this video is to provide comprehensive relevant information to IMG surgeons about the

Fellowship Examination. It is envisaged that this resource will provide candidates with information regarding

the format of the examination and candidate performance expectations. An aim of this resource is to improve

IMG pass rates at FEX, which have been less than the Surgical Education and Training (SET) trainee pass

rates.

Both eLearning resources are available to all IMGs who have accepted a specialist pathway and can be

accessed by the IMGs logging into their portfolios.

YY Make information available to future applicants that may allow them to assess the likelihood of their application achieving substantially or partially comparable status prior to them making a substantial financial payment that historical evidence might suggest is unlikely to succeed.

RACS has undertaken a 5-year analysis of the outcomes of IMG assessments in Australia and has published

information on the RACS website to enable IMGs to self-assess the likelihood of their application achieving

substantially or partially comparable status prior to making an application. The information to guide IMG

applicants is available on the RACS website.

https://www.surgeons.org/becoming-a-surgeon/international-medical-graduates/img-application-form/



35

Condition 34 All College and Specialty Training Board SIMG assessment processes and associated documentation must reflect the Medical Board of Australia and Medical Council of New Zealand guidelines by ensuring that both training and post-training experience are appropriately considered in assessments of comparability.

To be met by: 2019

The International Medical Graduates Committee (IMGC) is currently reviewing IMG policies to ensure that both

training and post-training experience are appropriately considered in assessments of comparability, and that

there is consistency between specialties.

The IMGC is currently considering the categories of post-training fellowship position/s completed by the IMG

which would be considered by the specialty training boards for assessment. The aim is to establish a set of

criteria which will be used by the specialty training boards to address identified gaps in the IMG’s pathway to

fellowship.

Condition 35 Develop and adopt alternative external assessment processes, such as workplace-based assessments, to replace the Fellowship Examination for selected specialist international medical graduates.

To be met by: 2020

There has been much progress by RACS in the development of a Work Based Assessment (WBA) tool which

could replace the Fellowship Examination for selected specialist IMGs.

The IMGC, Principle Educator and Clinical Director have developed a list of competencies to be assessed

during WBAs and the type of assessments to be utilised in order to make an assessment.

A WBA course will run in August 2018 to train assessors on the standards to ensure quality assessments are

undertaken during the planned pilots of WBA training.

The pilots will include six IMGs who are currently on a specialty pathway, two assessors from the same surgical

specialty and an external assessor. Pilots of WBA training will be delivered in the second half of 2018.


The numbers of applicants and outcomes for Specialist IMG assessment processes for Fellowship for the last

12 months, broken up according to the phases of the specialist international medical graduate assessment

process.

Table 15 New Applicants undertaking specialist international medical graduate assessment

Number of new applicants since last progress report:

Australia New Zealand

1 August 2017 – 31 July 2018 65 -



36

Table 16 Number of specialist international medical graduates assessments for Fellowship (1/08/2017-

31/07/2018)

Phase of IMG assessment Australia New Zealand

Initial Assessment N/A N/A

Interim Assessment Decision:

Not Comparable 27 -

Partially Comparable 29 -

Substantially Comparable 15 -

Ongoing Assessment 56 2

Final Assessment 28 2

Total: 155 4

Appendices

37

Progress Report 2018 Appendices

38

Summary of appendices

Appendix 1: RACS Executive Leadership Team 39

Appendix 2: Policy REL-GOV-11 Appeals Mechanism 41

Appendix 3: Education program of works 2018-2020 49

Appendix 4: Flexible training posts 53

Appendix 5: Responding to trainees who provide Feedback 57

Appendix 6: ANZ Journal of Surgery articles 61

Appendix 7: Surgical News article 71

Appendix 8: RACS Activities Report 2017 75

Appendix 9: Guidelines: Standards for supervision 143

Appendix 10: Specialty responses 155

APPENDIX 1

RACS Executive Leadership Team

39

Leanne.Hook

Typewritten Text


RACS executive leadership team

Note to Appendix 1:

Abbreviation Title Incumbent

CEO Chief Executive Officer Ms Mary Harney

Deputy CEO Deputy Chief Executive Officer Mr John Biviano

COO Chief Operating Officer Ms Emily Wooden

EGM Education Executive General Manager Education Ms Robin Buckham

(interim appointment)

EGM Partnerships Executive General Manager Partnerships Ms Susan Wardle

40

APPENDIX 2

Policy: REL-GOV-11 Appeals Mechanism

(Version 5 . September 2014)

41

Progress Report 2018 Apendices

Leanne.Hook

Typewritten Text

POLICY ROYAL AUSTRALASIAN COLLEGE OF SURGEONS

Division Relationships & Advocacy Ref. No. REL-GOV-011

Department Governance Support

Title Appeals Mechanism

Authorised By: Director, Relationships & Advocacy Original Issue: January 2009

Document Owner: Director, Relationships & Advocacy Version: 5

Approval Date: September 2014

Page 1 of 6 Review Date: September 2017

1. PURPOSE AND SCOPE

This policy sets out the mechanism for appeal by any person, or organisation (the appellant) adversely affected by a decision of the College that is inconsistent with approved College policy.

An appellant who has been directly and adversely affected by a decision that is inconsistent with approved College policy and/or procedure may apply to the Chief Executive Officer (CEO) of the College to have the decision considered by the Appeals Committee. An appeal to the Appeals Committee cannot result in a re-making by the Appeals Committee of the appealed decision. Rather, a successful appeal will result in the referral of the matter back to a College body for the making of a fresh decision subject to any terms and conditions imposed by the Appeals Committee.

2. KEYWORDS

Appeal; Policy; Procedure; Decision; Recommendation; Reconsideration; Committee; CEO;

3. BODY OF POLICY

3.1 Internal Review

3.1.1 An appellant may, prior to lodging an appeal, by direct request to the original decision maker, seek a review of any decision made by a College Board or Committee. A review may be requested where there is evidence that approved policy or procedure was not correctly applied or that there are pertinent matters of fact that existed at the time but were not known to the decision maker that may have persuaded the decision maker to reach an alternate decision.

3.1.2 An appellant may request copies of documents on which the decision was based. The College committee or board will provide such information within four weeks of receipt of a written request, subject to obligations of privilege, privacy and confidentiality which may apply.

3.1.3 Any request for an appeal against a decision must be made within three months of receipt of notice of the decision and will initially be processed as a review. The College aims to complete the review process within six (6) weeks and will notify the appellant of the outcome.

3.1.4 On receipt of notification from the College of the outcome of the review the appellant may:

i) Accept the decision and the result of the internal review; or

ii) Within two (2) weeks request in writing that the Executive Director for Surgical Affairs (EDSA) convene a hearing of the Appeals Committee.

iii) If no correspondence is received within two (2) weeks this will constitute acceptance of the review.


42









3.2 Appeal Initiation

3.2.1 The Appeal Request to the EDSA must include:

i) The prescribed appeal fee, and

ii) Details of the specific decision that is being contested, and

iii) The Grounds of Appeal, based on the allowable Grounds of Appeal (see 3.3), and

iv) Details of how the decision being appealed does not conform to approved College policies and/or procedures, and

v) Documented and verifiable evidence in support of the Grounds of Appeal

3.3 Grounds of Appeal

3.3.1 The Decisions which may be considered by the Appeals Committee are:

a) Decisions of the Education Board, Board of Surgical Education and Training, Court of Examiners, Surgical Training Boards (incl. the Australian Orthopaedic Association Board of Orthopaedic Surgery) and Regional Subcommittees of Surgical Training Boards in relation to selection, in-training assessment, and examination of trainees.

b) Decisions of Boards and Committees in relation to application for admission to Fellowship.

c) Decisions of Boards and Committees in relation to the specialist assessment and clinical assessment of International Medical Graduates (IMGs).

d) Decisions of the Board of Professional Development and Standards in relation to the Continuing Professional Development Program.

e) Decisions of the Education Board on the advice of the Board of Surgical Education and Training in relation to accreditation of hospitals and posts for training, or supervisors of training.

f) Decisions of the College in relation to the accreditation of Post Fellowship Education and Training programs and Accreditation of Courses.

g) Decisions of Complaints Committees - Council and RegionalDecisions of the Treasurer in relation to the financial status of Fellows, trainees, or other persons.

h) Such other decisions of the College, its Boards or Committees as the Council may determine from time to time.


43









3.3.2 An appeal may only be made on one or more of the following grounds:

a) That an error in law or in due process occurred in the formulation of the original decision.

b) That relevant and significant information existing at the time of the original decision, and which should have been known to the decision maker was not considered or not properly considered in the making of the original decision.

c) That the original decision was not one at which a rational decision-maker could have arrived in good faith.

d) That irrelevant information was considered in the making of the original decision.

e) That the original decision was made for an improper purpose.

3.4 Acceptance of Appeals

3.4.1 Requests for appeals are not accepted where the appellant is seeking an exemption from approved College policy.

3.4.2 The EDSA shall, within four (4) weeks of receipt of a properly initiated appeal in accordance with section 3.2 of this policy, advise the appellant and the original decision maker that an appeal will be heard. This advice will include:

a) The date, time and place of the hearing (which shall not be less than 6 weeks from the date of notice).

b) The right and expectation of the appellant to appear before the Appeals Committee

c) The right of the appellant to be accompanied by a legal representative to act as an advisor.

d) The right of the appellant to have a support person present.

e) All relevant documentation held by the College, subject to obligations of privilege, privacy or confidentiality which may apply.

3.4.3 Acceptance of an appeal does not prevent the decision under appeal from remaining in effect until the appeal is heard and determined.

3.5 Submissions to the Appeals Committee

3.5.1 In any appeal, the appellant will carry the onus of proof to establish the grounds of the appeal.

3.5.2 At least 4 weeks prior to the hearing the appellant will provide the College with written submissions and copies of any documents and records upon which he/she wishes to rely. This written submission must be within the context of the original submission for an appeal, and cannot introduce new grounds of appeal. A copy of the submission will be made available to the original decision maker.


44









3.5.2 At least 4 weeks prior to the hearing the original decision making authority will provide the Office of the EDSA with written submissions and copies of any additional documents and records relevant to the decision made, being the subject of the appeal. A copy of the submission will be made available to the appellant.

3.5.3 Both the appellant and the original decision maker may lodge a rebuttal submission up to 2 weeks before the scheduled appeal date.

3.5.4 The Appellant’s submissions and the Decision maker’s submissions will be provided to the Appeals Committee and no further material will be accepted after this time

3.5.5 Should the appellant have late documentation that he/she wishes to present to the Appeals Committee but is prohibited by 3.5.5 they may elect to cancel the scheduled meeting and convene a new appeal at a later date. In this situation the fee for the scheduled appeal will be forfeited and a new fee payable prior to a new hearing date being set.

3.6 Appeals Committee Composition

3.6.1 An Appeals Committee will be convened comprising the following members, who must not have been a party to the decision to which the appeal relates, or have any known conflict of interest:

Three persons who are not Fellows of the College.

The Vice President of the College, or delegate

One Fellow of the College (from a specialty not involved in the subject matter of the appeal).

3.6.2 The Chair is nominated by Council or its delegate, from the non-Fellow members of the Appeals Committee.

3.6.3 Council has delegated the appointment of Committee members (in accordance with this policy) to the Executive Director for Surgical Affairs (Australia).

3.6.4 A quorum for meetings of the Appeals Committee will be the Chair and three other members. All members of the Appeals Committee shall be entitled to vote on decisions and the outcome of the appeal shall be decided on the basis of a majority vote. In the event of a tied vote, the Chair will exercise a casting vote.

3.6.5 A Council nominated Solicitor shall be the Legal Adviser to the Appeals Committee.

3.6.6 The College In-house Counsel shall be the legal advisor to the relevant decision maker.

3.6.7 Other College staff may also attend at the invitation of the EDSA.


45









3.7 Rules for Conduct of Meetings of the Appeals Committee

3.7.1 Subject to these rules, the Appeals Committee must act according to the rules of procedural fairness. The Appeals Committee is not bound by the rules of evidence and, subject to these rules and rules of procedural fairness may inform itself on any matter and in such manner as it thinks fit.

3.7.2 The Appeals Committee shall be entitled to consider all relevant information which it thinks fit and may invite any person to appear before it, or to provide information. Witnesses are not compellable.

3.7.3 The Appeals Committee shall conduct its affairs with as little formality as possible and in accordance with the procedures set out in these rules, but otherwise, subject to these rules, shall have full power to regulate its conduct and operation.

3.7.4 An appellant has the right and responsibility to appear before the Appeals Committee and to advocate orally the merits of the appeal himself /herself as represented through written submissions.

3.7.5 The appellant has the right to be advised by a legal representative or support person. Legal advisors and/or support persons may not act as advocates for the appellant but the legal advisor (if any) may be invited to address the Appeals Committee regarding any particular legal issue that the Appeals Committee believes cannot adequately be addressed by the appellant.

3.7.6 A representative(s) of the relevant decision maker is expected to attend and address the Appeals Committee on matters relevant to the appeal and will be given equal opportunity to comment on submissions of the Appellant and the Decision maker. The College In House Counsel may not act as an advocate but may be invited to address the Appeals Committee regarding any particular legal issue that the Appeals Committee believes cannot adequately be addressed by the original decision maker.

3.7.7 Hospitals sponsoring International Medical Graduates (IMG) for an Area of Need position may appeal on behalf of the IMG and will be designated as the appellant.

3.8 Decisions of the Appeals Committee

3.8.1 An Appeals Committee may, upon considering all submissions:

a) Confirm the decision which is the subject of the appeal or

b) Revoke the decision and refer the decision to Council or an appropriate Board or Committee for the making of a fresh decision (upon such terms or conditions as the Appeals Committee may determine).

3.8.2 Amongst other things, a decision of the Appeals Committee cannot:

a) Elevate the appellant above others in a competitive assessment for selection to the SET program without reference to the scoring process;

b) Recommend a pathway to Fellowship for an IMG without reference to a new IMG Assessment Panel;

c) Revoke the clinical or examination assessment of a trainee and replace the assessment with an assessment of its own, or


46









d) Award a Fellowship to any appellant.

3.9 Reporting

3.9.1 The Appeals Committee will issue a written decision, with reasons for the decision, no more than eight weeks after the completion of the appeal hearing

3.9.2 The decision of the Appeals Committee takes effect from the date of forwarding of the decision to the parties by the EDSA.

3.9.3 Where the appellant is successful (ie, the decision under appeal is revoked), 50% of the appeal fee paid will be refunded.

3.9.4 The Executive Director for Surgical Affairs will report to Council annually on the activities of the Appeals Committee, including the number of appeals lodged and the results of appeals and any recommendations to Council from the Appeals Committee.

4. ASSOCIATED DOCUMENTS

Approver CEO Authoriser Council


47

48

APPENDIX 3

Education Program of Work 2018-2020

49


Red text = AMC conditions to be satisfied in 2018 report

1 SET Relationships 1. To improve the current relationships, with more emphasis on

collegiality, collaboration and shared responsibility.

Willingness of RACS, STBs and Societies to engage. 1, 2, 3, 4 1.1 CEO and President roadshow

2. To build greater mutual assurance and trust. Collaboration on the implementation of the education program of

work and delivery of AMC conditions.

1.2 Relationships and governance revised leading to greater

efficiencies

Assurance that SET policy is being consistently maintained. 1.3 MOUs and service agreements re-negotiated.

2 Surgical Supervisors 1. To professionalise and add status to the supervisor role. An engaged and skilled cohort of supervisors. 19, 20, 30, 31,

32, 33

2.1 Supervisor standards/roles defined and agreed by BSET (complete

June 2018).

2. To define standards for supervisors and review supervisor

performance.

Supervisors lead colleagues who teach and train SET trainees. 2.2 Implementation of OWR in 2018.

3. To support supervisors in providing optimal learning environments for

trainees and IMGs through understanding of, and stronger emphasis on,

regular, routine performance feedback, and improved performance-

management of trainees.

Change management is supported and implemented through

supervisors.

2.3 Development of educational resources as required, building on

FSSE and OWR.

4. Establish feedback processes from supervisors/trainees Advocacy with hospitals and networks is active and productive. 2.4 Cultural safety training (D&I and Indigenous Health).

Supervisor standards implemented 2.5 Advocate for protected time for supervisors

3 Trainees 1. To determine the factors which promote or inhibit choosing surgery as

a career.

Diversity and inclusion become the norm and flexible training is

accepted and accessible.

13, 18, 27, 28,

29, 32

3.1 Undergrad survey in progress.

2. To develop support mechanisms, enabling early interventions. Transparency in training and associated fees. 3.2 Attrition monitored and reported.

3. To determine the early indicators of trainees' success. 3.3 Specialties promote flexible training opportunities

4. Review and evaluate JDocs Framework. 3.4 Selection standards encourage equity of access for minority and

disadvantaged groups

5. Evaluate supports such as "boot camps" and trainee induction

workshops.

3.5 Associated research on "early years" to commence mid year. Will

also note JDocs influence

6. To advocate for, and support, trainee wellbeing initiatives Trainees learn and work in enviroments that support their wellbeing

and resilence.

3.6 Advocate for protected teaching time

7. To enable trainees to raise issues and provide feedback. Hospitals adhere to OH&S legislation 3.7 Liaison and advocacy with hospitals and jurisdictions.

3.8 Develop processes to protect and support trainees

4 International Medical

Graduates

1. To better support IMGs on their pathway to FRACS, and improve the

process of assessment.

More efficient IMG progress on pathway to Fellowship through

better supervision and oversight.

34, 35 4.1 Review of IMG assessment and interview process.

2. To develop alternative work based assessment processes to reduce

reliance on the Fellowship Examination for selected IMGs shown to be

performing well.

4.2 Development of WBAs; revised clinical assessment.

4.3 Training for Clinical Supervisors.

4.4 Working with STBs to implement changes to IMG assessment

processes.

5 Graduate Outcomes 1. To define the SET graduate outcomes and the expectations of new

graduates.

Well-rounded surgeons, who meet community expectations,

contribute to the efficiency, quality and safety of healthcare and

who work with, and for, a diverse community.

5, 6, 7 8, 9, 5.1 Survey of new graduates

2. Enable new surgeons to be confident to work in most communities Clear statements define graduate and program outcomes. 5.2 Statements include RACS education purpose as related to

community views and needs.

3. Relate program outcomes to community need. 5.3 Graduates aware of their expected broader roles in health system.

5.4 Program outcomes responsive to community needs re workforce,

including regional/rural practice.

High Level Tasks / Projects:Ref

EDUCATION PROGRAM OF WORK 2018 - 2020

RefLink to AMC

Condition:OutcomesObjectives Program

Education Program of Work V2 1


50

Red text = AMC conditions to be satisfied in 2018 report

High Level Tasks / Projects:Ref

EDUCATION PROGRAM OF WORK 2018 - 2020

RefLink to AMC

Condition:OutcomesObjectives Program

6 Fellowship Examination 1. To ensure better preparation for the FEX, and improved sign off

criteria related to work based assessment.

Improved FEX pass rates for trainees and IMGs - reducing the

number of candidates who sit two or more times.

12, 14 6.1 Initial review of FEX feedback reports for presentation to Senior

Examiners in April.

2. To improve Snr Examiners' written feedback reports providing

consistent and relevant information for the trainee and their supervisor.

Certification by FRACS represents completion of the entire SET

program

6.2 Implement revised FEX feedback reports in May.

3. To determine the factors that impact on multiple fail candidates and

the comparatively poorer performance of IMGs.

6.3 Implementation of improved sign-off June - October.

7 Assessment 1. To pilot, implement and evaluate WBAs Improved programmatic assessment of trainees throughout their

training.

12, 14, 15, 16 7.1 Response to Review of Assessments Report. Present to BSET in

June 2018

2. To determine a definition and utility of CBME in SET Improved work-based assessments, leading to the early detection

and remediation of underperformance.

7.2 Standard setting for SSEs (AMC16) to be implemented by 2018

3. To respond to the 'Review of Assessments' report Better use of WBAs throughout SET, to guide training. 7.3 Research into WBA. Direct board representation required

Evaluation of WBAs and approaches to assessment inform CBME. 7.4 New WBAs including EPAs developed and piloted with boards

Response is complete, considerd and actioned. 7.5 Research project findings presented to BSET

7.6 Assessments developed for broader generic/professional curriculum

8 Curriculum 1.To develop a generic professional curriculum. Greater emphasis of professional competencies is embedded into

SET

8, 9, 10, 11,14 8.1 Presentation of draft module/s at BSET (Oct 2019)

2. Develop suitable assessments. Cultural competency is achieved 8.2 Develop assessment processes (June 2019)

3. Implement the generic curriculum progressively. Roles in the health care system are understood 8.3 Ongoing work to pilot and implement in 2019.

4. Specialty curricula are linked to stages of training and mapped to

outcomes

Specialty curricula are well-defined 8.4 Integrate into BRIPS education as appropriate. e.g. FSSE for senior

trainees

9 Selection 1. Define and Document minimum standard of entry. The selection process allows the identification of candidates most

likely to succeed in SET.

24, 25, 26, 27 9.1 Evaluation of selection 2013 -

2. Increased number of indigenous trainees. Surgical trainees reflect the diversity of the community. 9.2 Selection Workshop planned (April 14).

3. Selection processes are evaluated, with reference to trainee progress

in SET.

Selection standards, pre-requisites and processes are transparent

and understood.

9.3 Presentation of research/workshop findings to BSET (June).

4. Information about surgical training and careers is widely available 9.4 Policy changes/implementation (Oct 2019).

10 Monitoring and

evaluation

1. Develop an overarching framework for monitoring and evaluation. Feedback mechanisms that provide data on the training programs

are established for trainees and supervisors.

4,17, 19, 20, 21,

22, 23

10.1 Linked to monitoring and evaluation of Respect and D&I plans.

Quarterly reports provided.

2. Develop a reporting structure that promotes data sharing between

RACS and the Societies/STBs.

Relevant and useful data for all internal and external stakeholders,

including government, is available.

10.2 Develop process for receiving feedback from external stakeholders.

3. Establish feedback mechanisms for trainees and supervisors. 10.3 Develop process for receiving feedback from trainees and

supervisors

4. Respond to Leaving Training Report. 10.4 Address Leaving Training Report

5. Trainee progress and attrition monitored quarterly. Publish related journal articles; One article published

6. Early Identification of trainees at increased risk. 10.5 Develop an overarching framework

7. Strategic support for trainees as appropriate.

Education Program of Work V2 2


51

52

APPENDIX 4

Flexible training posts per specialty and region

53



Flexible training posts by specialty

54


Flexible training posts by region

55

56

APPENDIX 5

Responding to and supporting trainees who provide feedback

Principles of Management

57



Responding to and supporting trainees who provide feedback

Principles of Management

1 The trainee is entitled to feel safe in providing feedback

Should a situation arise that threatens or disadvantages the trainee as a result of providing feedback, the Specialty Training Board and RACS management will be responsible for enacting measures to protect the trainee’s wellbeing and career progression.

2 The Specialty Training Board and RACS management work in unity to ensure the welfare of the trainee.

The Specialty Training Board is responsible for managing the trainee, and will remain the focal point in this situation. However, to ensure a considered and cohesive response to the situation in the trainee’s best interest, Specialty Training Boards will work closely with RACS management to consider a broad range of options and to implement appropriate actions. Such situations may require differing levels of support and intervention and the options could include seeking legal advice, providing psychological support for the trainee, advocating to the unit or hospital, intervention by the Executive Director of Surgical Affairs or the consideration of remedial action or sanctions.

3 Open disclosure and lines of communication are established in a prompt and timely manner

Where anonymity or the individual’s confidentiality is breached and as soon as the breach is suspected or identified, the breach must be communicated to the trainee (if not already aware) and their Specialty Training Board. The same process will apply for reporting of repercussions. The source could be the trainee, others associated with the feedback, administrative staff, and seniors in the clinical workplace, RACSTA, the training supervisor or the Board Chair. So the source may be varied and multiple.

Regardless of the source, the priority will be to establish early and open lines of communication between the trainee, the Specialty Training Board and RACS management. The Board will be the initiator of advice to the trainee and RACS management if either is unaware. Should the breach be disclosed or a report provided to RACS management, the Specialty Training Board will be advised, who will then be responsible for advising the trainee.

Once the breach or report is shared between the trainee, the Specialty Training Board and RACS management, discussions should commence without delay. Thereafter, the trainee will be consulted and actively involved in the process to determine the ongoing support and management of their specific situation.

4 The wellbeing and safety of the trainee is managed as a priority.

The primary concern is the wellbeing and safety of the trainee. The Specialty Training Board will take measures to ensure that the trainee is in a safe environment (physical safety) and that their mental health is supported (psychological safety). As needed, assistance from RACS managment will be provided.

Determining the trainee’s level of concern either perceived, real or having the potential to affect the trainee, will be a primary consideration. The situation will be discussed with the trainee to gauge if the trainee has been subject to any immediate repercussions and to evaluate the effect on the trainee (e.g. feeling threatened, anxious, stressed, or not concerned). In most circumstances consultation would be undertaken by the Board, but could be conducted by RACS management.

58


Measures undertaken will be appropriate to the level of concern and the potential for harm, and could range from mentoring or counselling to more serious measures such as immediate removal of the trainee from a training post.

5 Early intervention occurs to minimise any adverse impact on the trainee.

The Board and RACS management will evaluate the extent of the situation, and in the event of inadvertent disclosure of a trainee’s identity or breach of confidentiality, the potential for wider dissemination of the trainee’s identity. Immediate and early intervention with the unit, colleagues or seniors may mitigate the development of ongoing or serious harm to the trainee’s wellbeing, reputation, or career progression. Measures could include mediation, intervention or may require stronger cautionary measures.

6 A support plan for the trainee is developed, including mitigation of potential risks.

Once immediate measures are in place, a plan will be developed to provide medium to longer term support for the trainee. This may be developed in conjunction with medium to longer term measures to minimise the adverse impact on the trainee. The trainee will need to be actively engaged with the process, and take individual responsibility where appropriate (e.g. learning to identify and self-manage stress, being prepared to engage in mediation or to or to transfer.

Consideration will be given to the trainee’s continued safety and wellbeing. An analysis of the potential for the trainee to be disadvantaged as a result of the situation should be made and measures implemented as part of the support plan. The potential for disadvantage could include being subject to restrictions on their training experiences, assessment bias, reputational discredit or personal attack all of which could affect the trainee’s career progression. The measures implemented should be appropriate to the level of perceived, real or potential disadvantage experienced.

7 A plan for follow up and monitoring is agreed to.

The management plan should include an agreed period/s of follow up to determine if support and interventional measures implemented have been effective, if additional issues have emerged, and if the trainee’s wellbeing is stable and has not deteriorated .

The recent external review of the complaints process has resulted in a Disclosure Statement (pending approval) on victimisation. These proposed principles, specific to the SET situation, will be used in conjunction with the Disclosure Statement.

59

60

APPENDIX 6

ANZ Journal of Surgery articles

P Truskett (2018) Soil, Seed or the tiller: why do trainees leave?

D Forel, M Vandepeer, J Duncan, D Tivey and S Tobin (2018) Leaving surgical training: some of the reasons

are in surgery

61


Soil, seed or the tiller: why do trainees leave?

I suspect that most senior surgeons would look upon their period oftraining with fondness. I recall listening to my supervisors whowould often talk in respectful terms of their teachers and the vastvolume of surgery they did and the long hours they worked. Theyseemed to have worked many more hours than I did as a traineeand did far more surgeries. I also look upon my days of trainingwith similar fondness. The work was hard and there is a recollec-tion of self-doubt during early training. Would I make the grade?But I did feel safe and well supported by my mentors. There wasalso a great deal of clinical and emotional support from my fellowregistrars. There may be a good reason for this. We knew eachother very well. Selection in those days was hospital based, so wehad worked together for some time before we were selected intotraining. We often went to the same medical school as there wereonly two medical schools in New South Wales at that time: SydneyUniversity and the University of New South Wales. Many of ourmentors we knew from our time were as medical students. We hada good idea of what to expect. We had no real expectation or evenknowledge of the College. There was a vague curriculum that reallyonly dictated our rotations, length of training and provided a logbook with minimum numbers per term. We were expected to knowthe scope of our specialty and face an exam at the end of our ‘time-based’ training that was conducted by the College. But of course,the senior surgeons tend to retain good memories as with time wesuppress the bad memories. It is a coping mechanism. The recollec-tions of the ‘good old days’ do not necessarily inform the present.

Things are quite different today with national or state-basedselection and large rotations, sometimes interstate or internationalin smaller specialties, to places where the trainee may have no realfamiliarity or connection. It can be a significant dislocation. Thereis also a well-defined intensive College training program in eachspecialty with defined time limits for task completion. It is easy tounderstand how a trainee may become overwhelmed by the trainingrequirements and feel very alone if sent to a strange environment.

Data from College activity statement indicate that trainees are leav-ing their training programs.1 Why is this happening?

In 2015, the College commissioned the Ardnell group to under-take an external review to better understand why trainees have vol-untarily left surgical training.2 This report was published in April2016. The Ardnell report is available on the College website andshould be read by all surgical trainers. In this issue, Deanne et al.use this report as a platform and have produced a review to look atsurgical trainee attrition.3 The Ardnell study identified 337 traineeswho left the training program from 2008 to 2014. This represented15% of the training cohort. Of these, 62% resigned by choice. Ofthose who voluntarily left their training program, two-thirds werewomen. This gender imbalance was particularly concerning. Manytrainees indicated that their reasoning for resigning was multifacto-rial, but there were three main factors that influenced a decision toleave surgical training:

• Inflexibility in the training program• An unacceptable culture in which to learn• The practise of surgery required an unacceptable lifestyle.The other important aspect regarding the voluntary leavers is that

they were not the underperformers. They were proceeding well intheir training.

In many ways, it is entirely acceptable for trainees to leave if it istheir perception that surgery is not for them. It is sad that they hadto work so hard to gain selection to the program only to find thatsurgery did not suit them. Could this possibly be a problem of selec-tion? There have been prospective American studies that havelooked at the perceptions of a surgical life as a selection tool per-haps reflective of emotional intelligence and resilience.4,5 Althoughthese studies have demonstrated a reduction in trainee attrition, thesefactors cannot be used in isolation. It is clear from the Ardnell reportthat some trainees have been derailed by being placed in an environ-ment of poor surgical culture. Furthermore, this culture is not neces-sarily reflective of the seniority or gender of the consultants. Some

394 Editorials

© 2018 Royal Australasian College of Surgeons

Progress Report 2018 Appendices 62

http://orcid.org/0000-0002-5951-9291

of the narratives in the Ardnell report are chilling; some describingdeliberate depersonalisation, bullying and public demeaning. Theseactivities are known to lead to burnout, which clearly lead to dissat-isfaction.6 It is interesting how a bad culture can be perpetuated longafter the original protagonist has left. Such a culture will not dissi-pate; it takes recognition, strong leadership and a lot of hard work tochange bad behaviour that has become normalized.

Our training Boards must continue to explore flexible training.Part of the difficulty here is separating the ‘service’ componentfrom the ‘training’ component of surgical training. Too often deci-sions are made on a rule-based process and not on evidence. Itwould be interesting to see how education may be enhanced byappropriate flexibility. Surely, a ‘competency-based’ training pro-gram should allow for this. The other issue relating to flexibility isa sudden unexpected assignment to a training post that geographi-cally separates a trainee from their family and domestic commit-ments. There should be no excuse for this. It should be possiblethat an SET 2 trainee and above could be provided with their rota-tions at least 12 months in advance or even for their entire program.A newly appointed SET 1 is more problematic, because of the shorttime between appointment and commencement, but there should bean attempt made to avoid distant placement. There will be contin-gency issues but they would be an exception rather than the rule.Realistic notice even if the posting is interstate or international canbe planned for by a trainee.

Concerning as the Ardnell report appears, it was commissionedon a cohort of leavers that predates the College’s ‘Building RespectImproving Patient Safety’ program. Let us hope that the criticalissues raised by our disenchanted trainees will be addressed by ourchange in culture.

So, is the trainee, the training or the trainer the cause for attri-tion? Perhaps it is all three, but where a toxic surgical cultureexists, things really have to change or we might lose the right totrain.

References1. Royal Australasian College of Surgeons. Activity reports. 2016. [Cited

12 Dec 2017.] Available from URL: https://www.surgeons.org/government/workforce-and-activities-reports/

2. Ardnell Group. Ardnell report. 2016. [Cited 15 Dec 2017.] Availablefrom URL: https://www.surgeons.org/media/25492594/ardnell-report.pdf

3. Forel D, Vandepeer M, Duncan J, Tivey DR, Tobin SA. Leaving surgicaltraining: some of the reasons are in surgery. ANZ J. Surg. 2018; doi:10.1111/ans.14393.

4. Kelz R, Mullen J, Kaiser L. Prevention of surgical resident attrition by anovel selection strategy. Ann. Surg. 2010; 252: 537–43.

5. Burkhart R, Thorley R, Guinto D, Yeo CJ, Chojnacki KA. Grit: a markerof residents at risk for attrition. Surgery 2014; 155: 1014–22.

6. Lin T, Liebert C, Tran J, Lau JN, Salles A. Emotional intelligenceas a predictor of resident well-being. J. Am. Coll. Surg. 2016;223: 352–7.

Philip G. Truskett, AM, FRACSDepartment of Surgery, Prince of Wales Clinical School, Sydney,

New South Wales, Australia

doi: 10.1111/ans.14423

Editorials 395



https://www.surgeons.org/government/workforce-and-activities-reports/

https://www.surgeons.org/government/workforce-and-activities-reports/

https://www.surgeons.org/media/25492594/ardnell-report.pdf

http://orcid.org/0000-0002-5836-5999

SPECIAL ARTICLE

Leaving surgical training: some of the reasons are in surgery

Deanne Forel ,* Meegan Vandepeer,* Joanna Duncan,* David R. Tivey* and Stephen A. Tobin†*Royal Australasian College of Surgeons, Research and Evaluation, Incorporating ASERNIP-S, Adelaide, South Australia, Australia and†Royal Australasian College of Surgeons, Melbourne, Victoria, Australia

Key wordsadaptation, psychologicalburnout, professional,education, preceptorship, stress, psychological.

CorrespondenceAssociate Professor Stephen A. Tobin, RoyalAustralasian College of Surgeons, College ofSurgeons Gardens, 250-290 Spring Street,Melbourne, Vic. 3002, Australia.Email: [email protected]

D. Forel BSc; M. Vandepeer PhD, BSc (Hons);J. Duncan PhD, BSc (Hons); D. R. Tivey PhD, BSc(Hons); S. A. Tobin MBBS, MSurgEd, FRACS.

This study was presented at the InternationalConference on Residency Education held atNiagara Falls on 30 September 2016.

Accepted for publication 19 December 2017.

doi: 10.1111/ans.14393

Abstract

In 2014, the Royal Australasian College of Surgeons identified, through internal analysis, aconsiderable attrition rate within its Surgical Education and Training programme. Withinthe attrition cohort, choosing to leave accounted for the majority. Women were significantlyover-represented. It was considered important to study these ‘leavers’ if possible. An exter-nal group with medical education expertise were engaged to do this, a report that is nowpublished and titled ‘A study exploring the reasons for and experiences of leaving surgicaltraining’. During this time, the Royal Australasian College of Surgeons came under seriousexternal review, leading to the development of the Action Plan on Discrimination, Bullyingand Sexual Harassment in the Practice of Surgery, known as the Building Respect, Improv-ing Patient Safety (BRIPS) action plan. The ‘Leaving Training Report’, which involvednearly one-half of all voluntary ‘leavers’, identified three major themes that were pertinentto leaving surgical training. Of these, one was about surgery itself: the complexity, the tech-nical, decision-making and lifestyle demands, the emotional aspects of dealing with seri-ously sick patients and the personal toll of all of this. This narrative literature reviewinvestigates these aspects of surgical education from the trainees’ perspective.

Introduction

The demands of becoming and being a surgeon are significant; they

impact the individual’s sense of wellness, potentially leading to

imperfect learning within surgical education and training (SET), as

well as the impaired quality of surgical health care. A systematic

review of qualitative studies assessing what it means to be a sur-

geon revealed a gap between the idealization that surgeons are

highly skilled professionals and the reality of a typical working

day.1 Orri et al. identified that the emotional and relational dimen-

sions of surgical practice can contribute to an individual’s internal

tensions. Ignoring these dimensions of surgery, or not adequately

preparing trainees to deal with them, may result in individual’s

questioning whether surgery is a career for them and, for some, to

make the decision to leave surgery.Trainee loss is a significant concern for surgical colleges world-

wide. A meta-analysis of 22 studies found that the international

attrition rate in general surgery trainees is 18%, with over half of

these being voluntary.2 Within the Australian and New Zealand

context, the Royal Australasian College of Surgeons (RACS) has

assessed attrition rates. An internal RACS evaluation of 2144

trainees embarking on the SET Program from 2008 to 2014 identi-

fied 337 individuals (15%) who did not finish the program, either

because of dismissal, failure at hurdle examinations or choice.

Forty-five recommenced with the same or another specialty. Of the

remaining 292, some 56% chose to leave (resigned), with women

2.5 times more likely to resign.3

To investigate the reason behind such major career decisions,

RACS commissioned an external group with medical education

expertise to design and conduct a survey and interview study of the

group.3 Eighty respondents out of the 162 who chose to leave

(resigned) responded. This was a significant response (one-half)

from doctors who were no longer involved with the SET program.

Their reasons were cumulative and varied. For most, there was a

significant amount of time between considering and ultimately leav-

ing training. Three major themes were identified: (i) inflexibility in

the training programme; (ii) an unacceptable culture in which to

learn; and (iii) having commenced surgical training, surgery was

judged the wrong career choice.3

These losses to the RACS SET Program occurred following a

competitive selection process designed to identify trainees who

could perform well in training and as future surgeons. Therefore,

© 2018 Royal Australasian College of SurgeonsANZ J Surg 88 (2018) 402–407

ANZJSurg.com


https://orcid.org/0000-0001-8400-900X

significant voluntary attrition is a concern for RACS as it may indi-cate issues with trainee selection, expectations or the training envi-ronment. The challenge is to understand why trainees decidesurgery is not the career for them as well as ensuring that training isa positive and empowering experience for those who complete theprogramme.

This narrative literature review summarizes key aspects regardingthe complexity of surgical training that lead to trainee loss and howboth the trainee and trainer can be proactive in establishing protec-tive strategies to reduce these losses.

Causes for withdrawal as part of overallattrition

The third theme identified in the RACS survey of trainees who leftsurgical training3 is relevant to understanding the complexity ofsurgical life and why previous RACS trainees felt surgery was thewrong career choice for them. Reasons proffered by respondentsincluded the experience of adverse events, feeling they lacked tech-nical competence, concerns of failure related to complex operationsand the risk of burnout and health issues as a result. Some traineesalso felt that surgeons were not positive role models and that theirlifestyle was not something to which they could aspire. One inter-view participant stated that their reason for leaving was ‘…a combi-nation of being a lifestyle choice as well as getting more of arealisation of what the job and lifestyle of a surgeon was actuallylike’.3 These reasons are reflected in the international literature,which is summarized below:

Burnout: Burnout is defined as emotional exhaustion, deperson-alization and a decreased sense of personal accomplishment thatcan distort career decisions, impact well-being, negatively affectpatient care and may contribute to a decision to leave surgical train-ing.4 The incidence of burnout in surgical trainees across specialtiesranged from 28% to 69%,5–8 and over half of those classified withburnout considered dropping out of training.7

Factors found to be associated with burnout in surgical traineesincluded high workload and working hours,7,9 difficulty in balan-cing professional and private life and not taking part in extracurric-ular activities.6,9 Other important factors included patientaggression, lack of gratitude from seniors, being assigned a level ofresponsibility perceived to be too high, working in units wheresenior surgeons did not support trainees or their patient care, work-ing in units where regular staff meetings were not scheduled, per-ceiving patient expectations to be unrealistic and poor peercollaboration.5,6,8,9

Lifestyle as a trainee: In 2017, Khoushhal et al. meta-analysed10 studies that reported reasons for attrition. This included a totalof 10 371 general surgery trainees from the United States, and themost common cause of voluntary attrition was found to be anuncontrollable lifestyle.2 Another study of 2033 general surgerytrainees, not included in Khoushhal et al.’s meta-analysis, alsoreported lifestyle factors, including the strain of work, excessivehours and the stress it puts on family life, as the most significantreasons for withdrawal.10

Health and personal considerations: Health and personal consid-erations identified by Khoushhal et al. included trainees own health,

family or spousal factors, financial burden, poor performance andimminent dismissal.2 Sullivan et al. found that trainees who with-drew from training considered training to be too long, expresseddissatisfaction with the personality required to become a good sur-geon and felt the personal cost of surgery was too great. In addition,those who left training were less satisfied with their operative expe-rience, felt their skills were not level appropriate, reported feeling‘in over their head’ and that their work volume left them fearfulthey would hurt someone.10 Overall, the trainees who withdrewwere dissatisfied with the training programme and felt they werenot the correct fit for surgery.10

Inability to ask for support: Sullivan et al. report that those wholeft training were less likely to ask their peers for help for fear ofnegative judgement; they perceived a lack of respect from attendingphysicians, were less likely to interact with attending physicians(consultant surgeons) socially, did not report having camaraderiewith their peers and felt they could not rely on other trainees forsupport when needed.10

Potential reasons for consideringleaving training

In addition to the abovementioned studies, two further internationalstudies were identified that surveyed current general surgerytrainees asking whether they had considered leaving training andwhy;11,12 32% of trainees had considered leaving training in onestudy (18% considered leaving very seriously and 14% somewhatseriously),12 and 58% considered leaving seriously in the otherstudy.11 Both studies found trainees more likely to consider leavingin their first and second postgraduate year (46% and 41%,respectively).11,12

Ginther et al. found that the most significant factors associatedwith thoughts of leaving was poor work–life balance (71%), con-cerns about future unemployment or underemployment (46%) andpoor quality of life (44%).12 Furthermore, Gifford et al. identifiedsleep deprivation (50%), undesirable future lifestyle (47%) andexcessive work hours (41.4%) as the reasons trainees consideredleaving training.11

In addition, both the Ginther et al. and Gifford et al. studiesinvestigated factors that prevented surgical trainees from leaving,effectively supporting the completion of the surgical programme. Inboth studies, the most significant factor that prevented trainees leav-ing was support from family or partners (14% of responders12 and65% of responders11). Other reported reasons for not leavingincluded enjoyment of work (42%), having invested too much timeto quit (34%), support from other trainees (64%) and the perceptionof being better rested (59%).11,12 It is important to note that, despiteconsidering leaving throughout their training period, many traineeswill go on to become successful surgeons.

Factors associated with the complexityof surgical life

Orri et al.’s meta-synthesis of surgeons’ perspectives about factorsaffecting their practice and well-being included 51 studies thatdocumented over 1000 surgeon interviews. This review identified

Complexity and attrition in surgical trainees 403



the following themes of a career in surgery that trainees may not beaware of prior to commencing surgical training.1

Surgeon image and identity: The importance of upholding a cer-tain image and identity was reported by the surgeons interviewedas not being addressed in their education. Surgeons reported feelingthe vulnerability of their professional identity given that it was sostrongly linked to their surgical outcomes.

Rules and guidelines: Surgeons found that rules and guidelinesoften did not fit the surgical model and, in some cases, were a hin-drance. Surgery often takes an unpredictable course, and the abilityto accommodate this with flexibility and innovative practices isvital for a successful surgeon.

Emotional involvement: Errors and adverse events were per-ceived by surgeons as a major source of unpleasant emotions, phys-iological stress, cognitive dysfunction and a range of negativefeeling that may have a harmful effect on their practice.

Difficulty communicating with patients: In some cases, patientsare unable or unwilling to consent to an ‘operative plan’ because oftheir unrealistic expectations, unquestioned faith and need forextensive explanations or non-compliance.

Team relations: Surgeons generally described a family-likeatmosphere in the operative room, but conflicts may occur, particu-larly with regards to training surgeons. The influence of rank andpower can become problematic, with issues surrounding image andleadership being prominent. The need to discuss and critique theperformance and success of their peers and trainees may cause con-cerns for a surgeon’s reputation and create conflict. The surgeonsinterviewed seldom reported turning to other surgeons for emo-tional support.1

Can trainees considering leaving beidentified?

Given what is known about the reasons for leaving or consideringleaving, as well as the insight from the work by Orri et al., is it pos-sible to predict the characteristics of surgical trainees who are mostat risk of attrition?13–16

A prospective National Study on the Expectations and Attitudesof Residents in Surgery was initiated in 2007 across the UnitedStates and was designed to identify characteristics that may predictwhich trainees are most at risk of non-completion. All postgraduateyear one trainees took part in a 68-item survey that focused onquestions regarding demographics, choice of residency programme,expectations for surgical training and personality.16 Of the 1048general surgery interns who began training in 2007, over 80% par-ticipated. Linkage data were available for 836 of these interns, and672 went on to complete residency. The survey identified that thefemale gender was the independent risk factor most strongly associ-ated with attrition, with women being 1.4 times more likely to leavetraining. For men, the most important predictor of attrition wastraining programme size, with 23% of men withdrawing from largerprogrammes compared with 16% from smaller programmes.16

Quillin et al. investigated whether there is a link between learn-ing style and attrition.14 They examined a 14-year database of sur-gical trainee learning style assessments, along with operative logdata, examination results and reasons for leaving surgical training

before completion. Individual learning styles were assessed usingthe Kolb Learning Style Inventory17 (LSI), which is a validated,self-assessment tool. Individuals were categorized by learning style,and a total of 441 LSIs were completed by 126 trainees during thestudy period (1999–2012).14 The authors characterized the learningstyles of general surgery trainees, finding that the majority wereaction-based learners. Those at most risk of attrition were traineeswho the inventory suggested learned by observation. In addition,these individuals had a less robust operative experience as theywere rated less ‘hands on’.14

Grit, defined as perseverance and passion for long-term goals,has been shown to predict trainee well-being.18 Salles et al. mea-sured grit using the Short Grit Scale, a validated measure of perse-verance, over 2 years in 115 trainees. Risk of attrition was alsomeasured by asking two questions: (i) at this point in time, howlikely is it you will complete residency training in your current spe-cialty? and (ii) in the past month, how often have you thought ofleaving your current residency programme? Actual attrition wasalso measured. After controlling for trainee age, gender, ethnicityand marital status, the authors found that grit was not a predictor ofcompletion.15

To successfully cope with emotional and relational demands ofsurgical life requires self-reflection and an individual’s capacity toregulate their own emotions and those of their patients and col-leagues, allowing them to manage stressors and work effectivelywith others. This is related to the concept of emotional intelligence,and Lin et al. investigated its relationship to wellness in surgicaltrainees.13 This single-centre study of 73 trainees identified thathigh emotional intelligence has a strong positive predictive valuefor wellness. Furthermore, emotional exhaustion, depersonalizationand depression were lower in those with a high index for emotionalintelligence, and the authors concluded that prospectively measur-ing emotional intelligence may identify individuals who can copeand even thrive in surgical training.13

Coping strategies are used by surgicaltrainees

Surgical trainees are subjected to potential prolonged sleep depriva-tion and high job demands, with only some control over their workschedules and tasks.19 While there are several studies describingcoping strategies used by medical professionals,20–26 techniquesspecifically used by surgical trainees to help them cope with theirlengthy training period are less well described. Four studies wereidentified that discuss strategies used by trainees to help them copewith stress and burnout.19,27–29 Descriptions of the coping strategiesemployed by trainees is provided in Tables S1 and S2.

Popular coping strategies identified in the literature include par-ticipation in activities outside of surgical residency, includingengaging in enjoyable activities, taking time out, making time forhobbies weekly or more often and exercise.19,27,29 Discussing con-cerns with colleagues; talking to family, friends and/or partnersabout concerns; and consulting others were also reported as helpfulstress-coping strategies.19,27,29 To a lesser extent, religion, prayingor belief in a faith were also reported as coping mechanisms.19

‘Supports’ such as high alcohol use and tobacco smoking must be


404 Forel et al.


considered ‘strategies’ that adversely impact health. An Americanstudy found that low alcohol use had a significant correlation as aprotective strategy against burnout.19 As for the use of alcohol as acoping measure in Australia and New Zealand medical profes-sionals, a systematic review commission by Beyond Blue failed toidentify any published literature.30

The use of mentorship as a coping strategy varied. As the fre-quency of contact with mentors increased, emotional exhaustiondecreased and personal achievement increased.19 Mentor type wasalso important; senior trainee or classmate mentors significantlydecreased emotional exhaustion, while classmate or faculty membermentors significantly increased personal achievement.19 Fellows orphysicians other than a faculty member were the least beneficial interms of reducing burnout and marital satisfaction.19 Another recentstudy ranked same-sex mentorship to be a significant positive influ-ence on women in surgery, leading the authors to conclude thatearly exposure to organizations that support women in surgery canpositively influence career choices.31

In summary, the coping strategies that trainees adopt are varied,and there does appear to be an active engagement by some traineesin managing the demands and stressors of undertaking surgicaltraining.

Programmes and interventions toprevent voluntary withdrawal

Given the positive impact of coping strategies gained by individuals,can these benefits to well-being be extended to all trainees throughstructured programmes? Eight studies were identified that assessedthe effectiveness of various initiatives to improve traineeretention.32–39 They included providing methods for identifying andcoping with stress,32–34,36 wellness programmes that promote a posi-tive work–life balance35,38 and mentorship.37,39 Programme detailsand a summary of their findings is provided in Tables S1 and S2.

All of the programmes and interventions identified were usefulin improving surgical trainee well-being to varying degrees. Partic-ularly successful stress coping interventions were values affirma-tion, mental practice and self-awareness; briefly, these interventionsinvolve:

Values affirmation: a short stress-reducing writing exercisewhereby participants select 2–3 core values important to them froma list of 12 (including family and friends, sports, music and reli-gion) and write a discussion piece to explain their choices.36

Mental practice: a systematic form of mental rehearsal whereparticipants imagine themselves performing an action without per-forming the physical movements.32

Lack of self awareness: this was noted by Hochberg et al. as fail-ing to recognize the signs and symptoms of stress and depressionamong surgical trainees, and they concluded that medical educatorsshould provide trainees with the necessary tools to identify emotionaland psychological impairment as part of their formal training.33

Discussion

Surgery is a complex profession that places significant demands onindividuals both during and post-training. This review has revealed

that there are numerous reasons for withdrawal from surgical train-ing. Many relate to what surgery ‘is’ and that potential trainees areunaware of this or find this unacceptable. Of note are issues aroundlifestyle (i.e. absence of balance in work–life relationship), dissatis-faction with the workplace culture, feeling unsupported and per-sonal reasons such as family or spousal pressure and health orfinancial issues that result in individuals deciding that surgery is notfor them.

Attributes that were found to correlate with the increased likeli-hood to complete training were male gender, being enrolled insmaller training programmes and being an active learner. Highemotional intelligence was also found to have a strong positive pre-dictive value for wellness. Perhaps tailoring trainee placement andmentorship programmes based on withdrawal risk profiling, inorder to mitigate potential attrition and provide early interventionwhere required, may be a way forward for surgical trainingprogrammes.

However, irrespective of risk profiling, the stress of training willremain. The most popular techniques used by surgical trainees toavoid or cope with stress and burnout were speaking to colleagues,family and friends about their concerns and taking time out to dohobbies or enjoyable activities. The challenge is to identify thosewho lack such support and help them foster relationships or offer aviable alternative.

Organizational strategies that are designed to help surgicaltrainees cope with training and reduce attrition include methods foridentifying and coping with stress, wellness programmes to pro-mote positive work–life balance and mentorship activities. Bittneret al. conducted similar recommendations on individual copingstrategies, which included cultivating and maintaining healthy per-sonal relationships and spiritual practices; seeking medical and/ormental health care when needed or directed; maintaining appropri-ate nutrition and physical fitness; and striving to establish and sus-tain work–life balance.4

Limitations to this review are that many of the findings reportedhave been based on studies that have used surveys. Given thatresponse rates varied, there may be response bias to questionsregarding reasons for withdrawal, individual strategies used to copewith stress and the benefits of different organizational programmesand interventions. There may be differences between respondentsand non-respondents, which limit the generalizability of theresponses. In addition, despite the assurance of anonymity, somerespondents may have altered their responses for fear of careerrepercussions. Ideally, identified strategies that have shown promiseshould be tested in comparative studies, preferably randomized, toconfirm their benefits and determine whether they reduce attritionrates in surgical trainees.

It is important to note that many of the studies included in thisreview were from US general surgery programmes. Whether theresults derived from trainees from one country or specialty are rep-resentative of those from other countries or specialties is unknown.However, the general themes emerging from the literature are simi-lar to those identified in the study of those trainees who left(resigned) the RACS SET Program.3

This review has covered withdrawal from the perspective ofretention of trainees in the programme by investigating what




individual- or programme-implemented coping strategies are effec-tive. However, it is possible that the problem of ‘leaving’ mightalso be attributed to trainee selection, and some focus should alsobe placed on the recruitment of trainees. Although characteristicscan be shown to correlate with or predict completion, care must beexercised to prevent reinforcing potential gender and racial biases.RACS has committed to its ‘Diversity and Inclusion Plan’ to reducesuch biases.40

The ‘complexities’ of surgical training and a surgical career arenot well researched; the question raised by another review iswhether the problem of withdrawal stems from whether trainees areunaware of the challenges of surgical residency or if the wrongtrainees are being selected.41 Indeed, Orri et al. suggested that opendialogue is needed to inform those considering surgery as a careerand that succeeding as a surgeon cannot rely solely on technicalexcellence. A surgeon is required to work as part of a team with allinvolved in the delivery of surgical care.1

The RACS SET Program was established during 2007–2008 andrequires trainees to demonstrate clinical skill, patient care and pro-fessional judgement across nine competency domains, whichinclude professional relationships and being moral and ethical. Ele-ments within these dimensions should prepare the young surgeonfor the complexity of surgical life and build aspects of their emo-tional intelligence to complement their technical skills. Evaluationof the emotional and relational dimensions of training programmesis required to ensure that these aspects of surgery are taught effec-tively to support the individuals and provide them with protectivestrategies to allow navigation through the complexities of theirworking and personal lives as a surgeon.

Conclusion

Withdrawal from surgical training is costly and undesirable for bothindividuals and programmes. Surgical trainees use various strate-gies to help them to cope with the demands of their intensive train-ing, and choosing to leave is the strategy used by some. It isimportant that surgical colleges and programmes develop a culturewhereby trainee work–life balance and well-being are promoted.Interventions that foster this, as identified from the literature,include the provision of stress identification and management strat-egies to all surgical trainees through their curriculum. There arenotable roles for training and career mentorship and the provisionof wellness programmes; promotion of social interaction and inclu-sion with peers; and psychological support and development of theindividual including their values and self-awareness.

Acknowledgement

This review was commissioned by the Royal Australasian Collegeof Surgeons.

Conflicts of interest

None declared.

References1. Orri M, Farges O, Clavien P-A, Barkun J, Revah-Lévy A. Being a

surgeon—the myth and the reality: a meta-synthesis of surgeons’ per-spectives about factors affecting their practice and well-being. Ann.Surg. 2014; 260: 721–9.

2. Khoushhal Z, Hussain MA, Greco E et al. Prevalence and causes ofattrition among surgical residents: a systematic review and meta-analy-sis. JAMA Surg. 2017; 152: 265–72.

3. Ardnell Group. A study exploring the reasons for & experiences ofleaving surgical training, edn. [Cited 12 Sep 2017.] Available fromURL: www.surgeons.org/media/25492594/ardnell-report.pdf

4. Bittner JG 4th, Khan Z, Babu M, Hamed O. Stress, burnout, and mal-adaptive coping: strategies for surgeon well-being. Bull. Am. Coll. Surg.2011; 96: 17–22.

5. Chaput B, Bertheuil N, Jacques J et al. Professional burnout amongplastic surgery residents: can it be prevented? Outcomes of a nationalsurvey. Ann. Plast. Surg. 2015; 75: 2–8.

6. Chati R, Huet E, Grimberg L, Schwarz L, Tuech JJ, Bridoux V. Factorsassociated with burnout among French digestive surgeons in training:results of a national survey on 328 residents and fellows. Am. J. Surg.2017; 213: 754–62.

7. Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National surveyof burnout among US general surgery residents. J. Am. Coll. Surg.2016; 223: 440–51.

8. van Vendeloo SN, Brand PL, Verheyen CC. Burnout and quality of lifeamong orthopaedic trainees in a modern educational programme:importance of the learning climate. Bone Joint J. 2014; 96-B: 1133–8.

9. Businger A, Stefenelli U, Guller U. Prevalence of burnout among surgicalresidents and surgeons in Switzerland. Arch. Surg. 2010; 145: 1013–6.

10. Sullivan MC, Yeo H, Roman SA et al. Surgical residency and attrition:defining the individual and programmatic factors predictive of traineelosses. J. Am. Coll. Surg. 2013; 216: 461–71.

11. Gifford E, Galante J, Kaji AH et al. Factors associated with general sur-gery residents’ desire to leave residency programs: a multi-institutionalstudy. JAMA Surg. 2014; 149: 948–53.

12. Ginther DN, Dattani S, Miller S, Hayes P. Thoughts of quitting generalsurgery residency: factors in Canada. J. Surg. Educ. 2016; 73: 513–7.

13. Lin DT, Liebert CA, Tran J, Lau JN, Salles A. Emotional intelligence asa predictor of resident well-being. J. Am. Coll. Surg. 2016; 223: 352–8.

14. Quillin RC 3rd, Pritts TA, Hanseman DJ, Edwards MJ, Davis BR. Howresidents learn predicts success in surgical residency. J. Surg. Educ.2013; 70: 725–30.

15. Salles A, Lin D, Liebert C et al. Grit as a predictor of risk of attrition insurgical residency. Am. J. Surg. 2017; 213: 288–91.

16. Yeo HL, Abelson JS, Mao J et al. Who makes it to the end?: a novelpredictive model for identifying surgical residents at risk for attrition.Ann. Surg. 2017; 266: 499–507.

17. Kolb DA. The Learning Style Inventory: Technical Manual. McBer &Co: Boston, MA, 1976.

18. Salles A, Cohen GL, Mueller CM. The relationship between grit andresident well-being. Am. J. Surg. 2014; 207: 251–4.

19. Sargent MC, Sotile W, Sotile MO, Rubash H, Barrack RL. Quality oflife during orthopaedic training and academic practice. Part 1: orthopae-dic surgery residents and faculty. J. Bone Joint Surg. Am. 2009; 91:2395–405.

20. Alosaimi FD, Almufleh A, Kazim S, Aladwani B. Stress-coping strate-gies among medical residents in Saudi Arabia: a cross-sectional nationalstudy. Pak. J. Med. Sci. 2015; 31: 504–9.

21. Anton NE, Montero PN, Howley LD, Brown C, Stefanidis D. Whatstress coping strategies are surgeons relying upon during surgery? Am.J. Surg. 2015; 210: 846–51.


406 Forel et al.


http://www.surgeons.org/media/25492594/ardnell-report.pdf

22. Basinska MA, Dziewiatkowska-Kozlowska K. The strategies of

coping with stress in workplace used by surgeons working in differ-

ent hospitals: a pilotage research. Pol. Przegl. Chir. 2012;

84: 76–81.23. Lemaire JB, Wallace JE. Not all coping strategies are created equal: a

mixed methods study exploring physicians’ self reported coping strate-gies. BMC Health Serv. Res. 2010; 10: 208.

24. Lepnurm R, Nesdole R, Dobson RT, Pena-Sanchez JN. The effects ofdistress and the dimensions of coping strategies on physicians’ satisfac-tion with competence. SAGE Open Med. 2016; 4: 2050312116643907.

25. Satterfield JM, Becerra C. Developmental challenges, stressors and cop-

ing strategies in medical residents: a qualitative analysis of support

groups. Med. Educ. 2010; 44: 908–16.26. Spiliopoulos K, Gansera L, Weiland HC, Schuster T, Eichinger W,

Gansera B. Chronic stress and coping among cardiac surgeons: a singlecenter study. Rev. Bras. Cir. Cardiovasc. 2014; 29: 308–15.

27. Aminazadeh N, Farrokhyar F, Naeeni A et al. Is Canadian surgical resi-dency training stressful? Can. J. Surg. 2012; 55: S145–S51.

28. Malik AA, Bhatti S, Shafiq A et al. Burnout among surgical residents

in a lower-middle income country – are we any different? Ann. Med.

Surg. (Lond.) 2016; 9: 28–32.29. Sargent MC, Sotile W, Sotile MO, Rubash H, Barrack RL. Stress and

coping among orthopaedic surgery residents and faculty. J. Bone Joint

Surg. Am. 2004; 86-A: 1579–86.30. Health Technology Analysts Pty Ltd for Beyond Blue. The mental

health of doctors – a systematic literature review, edn. [Cited 20 Sep2017.] Available from URL: http://resources.beyondblue.org.au/prism/file?token=BL/0823

31. Faucett EA, McCrary HC, Milinic T, Hassanzadeh T, Roward SG,

Neumayer LA. The role of same-sex mentorship and organizational

support in encouraging women to pursue surgery. Am. J. Surg. 2017;

214: 640–4.32. Arora S, Aggarwal R, Moran A et al. Mental practice: effective stress

management training for novice surgeons. J. Am. Coll. Surg. 2011; 212:225–33.

33. Hochberg MS, Berman RS, Kalet AL, Zabar SR, Gillespie C,Pachter HL. The stress of residency: recognizing the signs of depressionand suicide in you and your fellow residents. Am. J. Surg. 2013;205: 141–6.

34. Maher Z, Milner R, Cripe J, Gaughan J, Fish J, Goldberg AJ. Stresstraining for the surgical resident. Am. J. Surg. 2013; 205: 169–74.

35. Salles A, Liebert CA, Esquivel M, Greco RS, Henry R, Mueller C. Per-ceived value of a program to promote surgical resident well-being.J. Surg. Educ. 2017; 74: 921–7.

36. Salles A, Mueller CM, Cohen GL. A values affirmation intervention toimprove female residents’ surgical performance. J. Grad. Med. Educ.

2016; 8: 378–83.37. Vulliamy P, Junaid I. Peer-mentoring junior surgical trainees in the

United Kingdom: a pilot program. Med. Educ. Online 2013; 18: 20825.38. Watson DT, Long WJ, Yen D, Pichora DR. Health promotion program:

a resident well-being study. Iowa Orthop. J. 2009; 29: 83–7.39. Zhang H, Isaac A, Wright ED, Alrajhi Y, Seikaly H. Formal mentorship

in a surgical residency training program: a prospective interventionalstudy. J. Otolaryngol. Head Neck Surg. 2017; 46: 13.

40. Royal Australasian College of Surgeons. Building Respect, ImprovingPatient Safety, edn. [Cited 13 Sep 2017.] Available from URL: https://www.surgeons.org/media/22260415/RACS-Action-Plan_Bullying-Harassment_F-Low-Res_FINAL.pdf

41. Singletary SE. A fire in our hearts: passion and the art of surgery. Ann.Surg. Oncol. 2010; 17: 364–70.

Supporting information

Additional Supporting Information may be found in the online ver-sion of this article at the publisher’s web-site:

Table S1. Coping mechanisms used by surgical trainees as reportedin the literature.Table S2. Programmes and interventions offered to surgicaltrainees to improve course retention as reported in the literature.




http://resources.beyondblue.org.au/prism/file?token=BL/0823

http://resources.beyondblue.org.au/prism/file?token=BL/0823

https://www.surgeons.org/media/22260415/RACS-Action-Plan_Bullying-Harassment_F-Low-Res_FINAL.pdf



70

APPENDIX 7

Surgical News article

N Vallance (2017) SET selection referee reports

71


Surgical News April 2017 https://www.surgeons.org/flipbook3d/Digital/SurgicalNewsApril2017/...

1 of 3 29/08/2017, 3:40 PM

Progress Report Appendices

72


2 of 3 29/08/2017, 3:40 PM


73


3 of 3 29/08/2017, 3:40 PM


74

APPENDIX 8

Activities Report 2017

75


Royal Australasian College of SurgeonsThe College of Surgeons of Australia and New Zealand

Activities ReportFor the period 1 January to 31 December 2017

Annual Activities Report January – December 2017© Royal Australasian College of Surgeons

Enquiries concerning this report and its reproduction should be directed to: [email protected] Progress Report 2018 Appendices

76

FOREWORD TO ACTIVITIES REPORTThe Royal Australasian College of Surgeons (RACS), formed in 1927, is a non-profit organisation training surgeons and

maintaining surgical standards in Australia and New Zealand. The College’s purpose is to be the leading advocate for surgical

standards, professionalism and surgical education in Australia and New Zealand.

RACS works in partnership with specialist surgical societies and associations to train medical doctors to become surgeons and

to deliver professional development activities to maintain the surgical skills and standards of our Fellows. We also work with

governments, hospitals and other organisations to ensure a well-qualified, experienced and appropriately distributed workforce in

Australia and New Zealand.

In 2017, 241 new Australian and New Zealand Fellows were admitted to RACS. This increases the number of active Fellows to

over 6300. We also had almost 1200 surgical trainees and 87 International Medical Graduates participate in surgical training over

the course of the year.

As part of the RACS Building Respect and Improving Patient Safety Action Plan, there have been additional training requirements

added to our Continuing Professional Development Program. We are proud of the achievements we have made in this area to

ensure the upskilling of surgical supervisors and trainers, and to promote a respectful culture within surgery.

The Activities Report provides detail of the surgical workforce and its distribution as well as information regarding surgical training

and examination results. The report is a document provided for Government departments of health, related agencies and those

with an interest in the activities of RACS. The data provided in this report is true and accurate as at December 2017.

Mr John Batten

President

Royal Australasian College of Surgeons


77

Royal Australasian College of Surgeons 2017 Activities Reporti

Table of ContentsLIST OF TABLES ii

LIST OF FIGURES iv

ACRONYMS v

INTRODUCTION vi

KEY DEVELOPMENTS FOR 2017 vi

SECTION ONE: ACTIVITIES OF SKILLS TRAINING 1

Explanatory notes 1

SECTION TWO: ACTIVITIES OF INTERNATIONAL MEDICAL GRADUATES 6

Explanatory notes 6

SECTION THREE: ACTIVITIES OF SURGICAL EDUCATION & TRAINING 14

Explanatory notes 14

Data summary 14

SECTION FOUR: ACTIVITIES OF EXAMINATIONS 28


Data summary 29

SECTION FIVE: WORKFORCE DISTRIBUTION 37


Data summary 37

SECTION SIX: PROFESSIONAL DEVELOPMENT AND STANDARDS 48


Data summary 48

SECTION SEVEN: ACTIVITIES OF RACS GLOBAL HEALTH 51


SECTION EIGHT: ACTIVITIES OF CONFERENCE AND EVENTS 55


SECTION NINE: ACTIVITIES OF RACS SKILLS AND EDUCATION CENTRE 56


Data summary 56

APPENDIX A: DEFINITIONS FOR REGIONAL, RURAL AND RRMA DATA 59


78

Royal Australasian College of Surgeons – The College of Surgeons of Australia and New Zealand ii

LIST OF TABLESSECTION ONE: ACTIVITIES OF SKILLS TRAINING 1TABLE ST.1 – Skills training course attendance by month and course 2TABLE ST.2 – Skills training course attendance by location and course 3TABLE ST.3 – ASSET faculty by location and specialty 4TABLE ST.4 – CCrISP faculty by location and medical discipline 4TABLE ST.5 – EMST faculty by location and medical discipline 4TABLE ST.6 – CCrISP and EMST attendance by location and pass rate 4TABLE ST.7 – CLEAR faculty by location, specialty and medical discipline 5TABLE ST.8 – TIPS faculty by location and medical discipline 5TABLE ST.9 – OWR Faculty by region, specialty and medical discipline 5

SECTION TWO: ACTIVITIES OF INTERNATIONAL MEDICAL GRADUATES 6TABLE IMG.1 – Number of International Medical Graduate applications activated by specialty 7TABLE IMG.2 – International Medical Graduate Countries of Training 7TABLE IMG.3 – Number of International Medical Graduates not comparable after initial paper based review 8TABLE IMG.4 – Number of applications withdrawn by International Medical Graduates 8TABLE IMG.5 – Specialist assessment pathway: International Medical Graduate outcome of initial assessment 8TABLE IMG.6 – Specialist assessment pathway: International Medical Graduate specialists under oversight / supervision 9TABLE IMG.7 – Area of need pathway: International Medical Graduate outcome of initial assessment 9TABLE IMG.8 – Area of need pathway: International Medical Graduate specialists under oversight / supervision 10TABLE IMG.9 – International Medical Graduate outcome of area of need assessment 10TABLE IMG.10 – International Medical Graduate outcome of final assessment 10TABLE IMG.11 – International Medical Graduate time for specialist recognition initial assessment 11TABLE IMG.12 – International Medical Graduate time for area of need assessment 11TABLE IMG.13 – International Medical Graduate time for specialist recognition final assessment 11TABLE IMG.14 – International Medical Graduate – number and outcome of appeal 11TABLE IMG.15 – Short-term specified training: International Medical Graduate specialist applications by specialty 12TABLE IMG.16 – Short-term specified training: International Medical Graduate specialist applications by location 12TABLE IMG.17 – Number of International Medical Graduate specialists practising in Australia 12TABLE IMG.18 – Applications for International Medical Graduate specialists 12TABLE IMG.19 – Interview outcomes for International Medical Graduate specialists applicants 12TABLE IMG.20 – International Medical Graduate specialists participating in vocational assessment 13TABLE IMG.21 – RACS review of recommendations for International Medical Graduate specialist applicants at the request

of the Medical Council of New Zealand 13

SECTION THREE: ACTIVITIES OF SURGICAL EDUCATION & TRAINING 14TABLE SET.1 – SET applications by specialty and applicant type 16TABLE SET.2 – SET applications by specialty and location of residence 17TABLE SET.3 – Individual SET applicants by number of applications and applicant type 17TABLE SET.4 – SET applications outcome by specialty and applicant type 17TABLE SET.5 – Successful SET application by specialty and location of residence 18TABLE SET.6 – Active SET Trainees by status and training location 19TABLE SET.7 – Inactive SET Trainees by status and training location 19TABLE SET.8 – Active SET Trainees by status and specialty 20TABLE SET.9 – Inactive SET Trainees by status and specialty 20TABLE SET.10 – SET Trainees that exited the SET program, by specialty 21TABLE SET.11 – SET Trainees that exited the SET program, by year of training 21TABLE SET.12 – SET Trainees that exited the SET program, by region 21TABLE SET.13 – Active SET Trainees by age and location of training post 22TABLE SET.14 – Active SET Trainees by age and specialty 22TABLE SET.15 – Active SET Trainees by years in training and training post location 23TABLE SET.16 – Active Cardiothoracic SET Trainees by years in training and training post location 23TABLE SET.17 – Active General Surgery SET Trainees by years in training and training post location 24TABLE SET.18 – Active Neurosurgery SET Trainees by years in training and training post location 24Progress Report 2018 Appendices

79

Royal Australasian College of Surgeons 2017 Activities Reportiii

TABLE SET.19 – Active Orthopaedic SET Trainees by years in training and training post location 25TABLE SET.20 – Active Otolaryngology SET Trainees by years in training and training post location 25TABLE SET.21 – Active Paediatric SET Trainees by years in training and training post location 26TABLE SET.22 – Active Plastic and Reconstructive SET Trainees by years in training and training post location 26TABLE SET.23 – Active Urology SET Trainees by years in training and training post location 27TABLE SET.24 – Active Vascular Surgery SET Trainees by years in training and training post location 27

SECTION FOUR: ACTIVITIES OF EXAMINATIONS 28TABLE EXAM.1 – SET Trainee pass rate of individual attempts (total sittings) at Generic Surgical Science Examination

by specialty and location 30TABLE EXAM.2 – Pass rate of individual attempts (total sittings) at Specialty Specific Surgical Science Examination by specialty and location 31TABLE EXAM.3 – Pass rate of individual attempts (total sittings) at Clinical Examination by specialty and location 32TABLE EXAM.4 – SET and IMG individual attempts and annual pass rate of Fellowship Examinations by specialty 33TABLE EXAM.5 – Eventual Fellowship Examination pass rate by specialty 33TABLE EXAM.6 – Fellowship Examinations pass rate (per sitting) of SET Trainees by location and specialty 34TABLE EXAM.7 – Fellowship Examinations pass rate (per sitting) of International Medical Graduates by location and specialty 34TABLE EXAM.8 – Fellowship Examinations pass rate (per sitting) of SET and IMG by gender and specialty 35TABLE EXAM.9 – SET Trainees and IMGs cumulative attempts to pass Fellowship Examination by specialty for candidates presenting in 2017 35TABLE EXAM.10 – Non-SET cumulative attempts to pass Generic Surgical Science Examination by location 36

SECTION FIVE: WORKFORCE DISTRIBUTION 37TABLE WFD.1 – Active and retired RACS Fellows by location and specialty 38TABLE WFD.2 – Active RACS Fellows by location and specialty 39TABLE WFD.3 – Active RACS Fellows by location and age 40TABLE WFD.4 – Active Australian RACS Fellows by specialty and age 41TABLE WFD.5 – Active New Zealand RACS Fellows by specialty and age 42TABLE WFD.6 – Active Australian RACS Fellows by RRMA code and specialty 43TABLE WFD.7 – Active Australian RACS Fellows by RRMA and location 43TABLE WFD.8 – Active Australian RACS Fellows by RRMA and age group 43TABLE WFD.9 – Active RACS SET Trainees obtaining RACS Fellowship in 2017 by location of residence and specialty 44TABLE WFD.10 – Active International Medical Graduates obtaining RACS Fellowship in 2017 by location of residence and specialty 45TABLE WFD.11 – Total number of SET Trainees and International Medical Graduates obtaining RACS Fellowship by specialty (2008 – 2017) 46TABLE WFD.12 – Ratio of active Australian and New Zealand RACS Fellows per population by location 47TABLE WFD.13 – Ratio of active Australian and New Zealand RACS Fellows per population aged 65 years or older by location 47

SECTION SIX: PROFESSIONAL DEVELOPMENT AND STANDARDS 48TABLE CPD.1 – Participation in RACS CPD program 2014 – 2016 by specialty 48TABLE CPD.2 – Participation in RACS CPD program 2014 – 2016 by region 49TABLE CPD.3 – Fellow participation in RACS and other CPD programs in 2016 49TABLE CPD.4 – Participation in RACS CPD program in 2016 by program category and specialty 49TABLE CPD.5 – Registrations in RACS MOPS program in 2016 50TABLE CPD.6 – Professional Development participation by location and status 50TABLE CPD.7 – Professional Development participation by specialty and status 50

SECTION SEVEN: ACTIVITIES OF RACS GLOBAL HEALTH 51TABLE GH.1 – RACS Global Health clinical visits 53TABLE GH.2 – RACS Global Health non-clinical visits 53TABLE GH.3 – International scholarships awarded to surgeons with hospital attachments in Australia, New Zealand or South East Asia 54TABLE GH.4 – International travel and educational grants – support for conference attendance 54

SECTION EIGHT: ACTIVITIES OF CONFERENCE AND EVENTS 55TABLE C&E.1 – RACS Annual Scientific Congress attendance 2017 55

SECTION NINE: ACTIVITIES OF RACS SKILLS AND EDUCATION CENTRE 56TABLE SEC.1 – Number of workshops held in the Skills Laboratory in 2017 57TABLE SEC.2 – Number of Skills Laboratory workshop participants in 2017 58

APPENDIX A: DEFINITIONS FOR REGIONAL, RURAL AND RRMA DATA 59Progress Report 2018 Appendices

80

Royal Australasian College of Surgeons – The College of Surgeons of Australia and New Zealand iv

LIST OF FIGURESSECTION FOUR: ACTIVITIES OF EXAMINATIONSFIGURE EXAM.1 – Overall annual pass rate of individual attempts (total sittings) at Generic Surgical Science Examination (2010-2017) 30FIGURE EXAM.2 – Overall annual pass rate of individual attempts (total sittings) at Specialty Specific Surgical Science Examination (2010-2017) 31FIGURE EXAM. 3 – Overall annual pass rate of individual attempts (total sittings) at Clinical Examination (2010-2017) 32FIGURE EXAM.4 –Overall Fellowship Examination pass rate of SET Trainees and IMGs (2010-2017) 36

SECTION FIVE: ACTIVITIES OF CONFERENCE AND EVENTS

FIGURE WFD.1 – Total annual number of SET Trainees and International Medical Graduates obtaining RACS Fellowship (2008–2017) 46

SECTION NINE: ACTIVITIES OF RACS SKILLS AND EDUCATION CENTRE

FIGURE SEC.1 – Surgical workshops held in the Skills Laboratory by specialty (either RACS or external workshop) 57FIGURE SEC.2 – Occupancy of the Skills Laboratory on a seven-day basis in 2017 57FIGURE SEC.3 – Total number of Skills Laboratory surgical workshop participants in 2017 by specialty 58FIGURE SEC.4 – Total number of Skills Laboratory workshop participants in 2017 by profession 58


81

Royal Australasian College of Surgeons 2017 Activities Reportv

ACRONYMS

~ Not available

ACT Australian Capital Territory

AOA Australian Orthopaedic Association

ASSET Australian and New Zealand Surgical Skills Education and Training

ATLASS Australia Timor Leste Program of Assistance for Specialist Services

AUS Australia

CAR Cardiothoracic Surgery

CCrISP Care of the Critically Ill Surgical Patient

CE Clinical Examination

CLE Clinical Epidemiology

CLEAR Critical Literature Evaluation and Research

CPD Continuing Professional Development

EMST Early Management of Severe Trauma

GEN General Surgery

GP General Practitioner

GSSE Generic Surgical Science Examinations

HECS Health Education and Clinical Services

HF Honorary Fellow

IMG International Medical Graduate

MCNZ Medical Council of New Zealand

MOPS Maintenance of Professional Standards

NEU Neurosurgery

No. Number

NSW New South Wales

NT Northern Territory

NZ New Zealand

OB & GYN Obstetrics and Gynaecology

OPH Ophthalmology

ORT Orthopaedic Surgery

O/S Overseas

OPBS Orthopaedic Principles and Basic Science Examination

OSCE Objective Structured Clinical Examinations

OTO Otolaryngology – Head and Neck Surgery

OWR Operating with Respect

PAE Paediatric Surgery

PAEE Paediatric Anatomy & Embryology Examination

PPPE Paediatric Pathology & Pathophysiology Examination

PGY Medical Graduate

PIP Pacific Islands Projects

PLA Plastic and Reconstructive Surgery

PRSSP Plastic Surgical Science and Principles Exam

QLD Queensland

RACS Royal Australasian College Of Surgeons

RRMA Rural, Remote and Metropolitan Areas

SA South Australia

SET Surgical Education Training

SSE Surgical Science Examination

SEAM Surgical Education and Assessment Modules

STST Short Term Specified Training

TAS Tasmania

TIPS Training in Professional Skills

URO Urology Surgery

VAS Vascular Surgery

VIC Victoria

VSEC Victorian Skills and Education Centre

WA Western Australia

WFD Workforce Distribution


82

Royal Australasian College of Surgeons – The College of Surgeons of Australia and New Zealand vi

INTRODUCTIONThe Royal Australasian College of Surgeons Activities Report outlines the developments and demographic data for the year 2017. As with previous reports, the purpose is to provide a comprehensive review of RACS activities throughout the year.

This report details activity in the following nine sections:

• Section One: Skills Training

• Section Two: International Medical Graduates

• Section Three: Surgical Education And Training

• Section Four: Examinations

• Section Five: Workforce Distribution

• Section Six: Professional Development and Standards

• Section Seven: RACS Global Health

• Section Eight: Conference And Events

• Section Nine: Skills And Education Centre

Each section reviews the purpose of and key findings in the data. This is followed by the data in table and graphical format where possible. Each of the nine sections in this report and the data selected has been provided to facilitate a review of activities. All data presented is for the year 2017, unless otherwise stated.

KEY DEVELOPMENTS FOR 2017The number of female surgeons in active practice increased by 7% in the last year, with women making up 12% of the active surgical workforce and more than 20% of the cohort who obtained RACS Fellowship in 2017.

The number of individual female SET applicants increased by 10%, and comprised almost one-third of all individual applicants. There were 255 applicants who were offered a trainee position in 2017. Just over 30% of successful applicants were female, a 6% increase from 2016.

There were almost 4000 participants who attended Professional Development programs in 2017, more than double the number of participants compared to 2016. This increase is largely due to the extra number of ‘Foundation Skills for Surgical Educators’ courses held during the year. As part of the Building Respect, Improving Patient Safety Action Plan, this course is now required to be completed by any Fellow who is a surgical supervisor or trainer. In 2016, 99.6% of Fellows complied with the RACS CPD program.


83

1Royal Australasian College of Surgeons 2017 Activities Report

EXPLANATORY NOTESThe Skills Training Department provides the following short courses:• Australian and New Zealand Surgical Skills Education and Training (ASSET)• Care of the Critically Ill Surgical Patient (CCrISP)• Critical Literature Evaluation and Research (CLEAR)• Early Management of Severe Trauma (EMST) • Training in Professional Skills (TIPS)• Operating with Respect (OWR)

Most of these courses are a mandatory requirement of Surgical Education and Training (SET). Doctors from a variety of medical disciplines are involved as both faculty and participants. These courses incorporate a mix of formative and summative assessment, with participants closely mentored and their performance appraised throughout the courses. Courses that incorporate summative assessment (pass or fail) also have an avenue for feedback to be given to SET and IMG surgical supervisors when required.

Successfully completing the Operating with Respect course is a mandatory requirement for SET Supervisors, IMG Clinical Assessors and key RACS committee members.

Australian and New Zealand Surgical Skills Education and Training (ASSET)ASSET is a requirement for all SET Trainees (excluding Neurosurgery), who are given first preference to complete the course. The course provides an educational package of generic surgical skills with an emphasis on small group teaching, intensive hands-on practice of basic skills, individual tuition, personal feedback to participants and the performance of practical procedures. Although this course is not formally assessed, attendees are required to attend and interact in all components in order to successfully complete it. Participants are required to complete ten eLearning modules prior to attending the course, and are provided with a suture jig and disposable instruments with which to practice.

Care of the Critically Ill Surgical Patient (CCrISP®)CCrISP® is a requirement for all SET Trainees, who are given first preference to complete the course. The course focuses on developing systematic skills for managing critically ill patients and promotes the co-ordination of multidisciplinary care where appropriate. The CCrISP® course encourages doctors to adopt a system of assessment to avoid errors and omissions, and uses relevant clinical scenarios to reinforce the objectives. Participants are assessed by their contribution to the various sections throughout the course, as well as their performance in a 45-minute simulated patient scenario.

Early Management of Severe Trauma (EMST)EMST is a requirement for all SET Trainees, who are given first preference to complete the course. EMST focuses on the management of injury victims in the first one to two hours post-accident, with emphasis on life-saving skills and systematic clinical approach. This course is assessed by contribution to the various sections, a 40-question multiple choice questionnaire paper, and a 15-minute simulated patient scenario.

Critical Literature Evaluation and Research (CLEAR)CLEAR is a requirement for General, Urology, Neurosurgery, Paediatric and New Zealand Orthopaedic SET Trainees, who are given first preference to complete the course. It is designed to provide tools to undertake critical appraisal of surgical literature and to assist surgeons in the conduct of clinical trials, aiming to make the language and methodology relevant to surgeons and the day-to-day activities in their practice. There is no formal assessment for this course; participants are required to attend and interact in all components in order to achieve certification. A dedicated consultant only course is run each year to cater to Fellows interested in attending.

Training in Professional Skills (TIPS)TIPS is a requirement for Australian based orthopaedic SET Trainees, who are given first preference to attend. TIPS focuses on patient-centred communication and team-oriented non-technical skills in surgery. Through simulation, participants address issues and events that occur in the clinical and operating theatre environment that require skills in communication, teamwork, crisis resource management and leadership. TIPS is designed to be generic to all specialties of surgical training and relevant to Trainees who have already undertaken 2 to 3 years of surgical training. There is no formal assessment for this course; participants are provided with direct feedback throughout the course and are required to attend all components to achieve certification. TIPS is a requirement for SET Trainees undertaking the Australian orthopaedic training program from 2017. TIPS participants are required to complete the JDocs Communication eLearning module prior to attending.

Operating With Respect (OWR)The Operating with Respect course was launched in April 2017. OWR is a mandatory requirement for all SET Supervisors, IMG Clinical Assessors and key RACS committee members by the end of 2018. The Operating with Respect course provides advanced training in recognising, managing and preventing discrimination, bullying and sexual harassment. The aim of this course is to strengthen patient safety by enabling participants to develop skills in respectful behaviour and practice strategies in responding to unacceptable behaviour. The course follows the release of the RACS Action Plan on Discrimination, Bullying and Sexual Harassment in the Practice of Surgery.

SECTION ONE ACTIVITIES OF SKILLS TRAINING


84


2Royal Australasian College of Surgeons – The College of Surgeons of Australia and New Zealand

Faculty The skills course volunteer workforce comprises of 1183 faculty members. Instructors are represented across all disciplines of medicine and surgery, with 139 (12%) teaching on more than one program. Representation of Fellows teaching on skills courses remains at 51% (N=609) with 3% (N=39) SET Trainees, 1% (N=10) International Medical Graduates and the remaining 38% (N=444) made up of emergency physicians, anaesthetists, physicians, intensivists, general practitioners, clinical epidemiologists and educators. The EMST and CCrISP® faculty include instructors local to Fiji and Papua New Guinea where outreach courses are held.

TABLE ST.1 – Skills training course attendance by month and course

Course JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DECTotal 2017

Total 2016

% Change

16/17

CCrISP Instructor Course

Courses 0 0 0 0 0 0 1 0 0 1 0 0 2 3 -33.3

Instructors 0 0 0 0 0 0 7 0 0 8 0 0 15 21 -28.6

Participants 0 0 0 0 0 0 15 0 0 13 0 0 28 35 -20.0

CCrISP Provider Course

Courses 0 3 3 2 1 2 3 1 4 3 3 1 26 28 -7.1

Instructors 0 35 36 28 13 27 38 11 57 36 35 12 328 379 -13.5

Participants 0 47 43 31 17 32 44 11 56 48 50 18 397 433 -8.3

EMST ADF Course

Courses 0 1 0 0 1 0 0 1 0 0 1 0 4 4 0.0

Instructors 0 9 0 0 10 0 0 10 0 0 10 0 39 39 0.0

Participants 0 15 0 0 16 0 0 16 0 0 15 0 62 59 5.1

EMST Instructor Course

Courses 0 0 1 0 0 0 0 0 0 0 1 0 2 2 0.0

Instructors 0 0 8 0 0 0 0 0 0 0 8 0 16 15 6.7

Participants 0 0 15 0 0 0 0 0 0 0 14 0 29 31 -6.5

EMST Provider Course

Courses 1 4 8 2 6 8 4 2 3 5 7 2 52 63 -17.5

Instructors 9 38 85 21 60 78 38 20 29 48 69 22 517 604 -14.4

Participants 16 64 125 30 94 119 60 29 41 74 110 32 794 1017 -21.9

EMST Refresher Course

Courses 0 0 1 1 0 0 1 0 1 1 1 0 6 6 0.0

Instructors 0 0 11 10 0 0 10 0 10 9 9 0 59 62 -4.8

Participants 0 0 14 15 0 0 12 0 15 13 16 0 85 93 -8.6

ASSET

Courses 0 2 3 1 4 3 1 4 2 4 0 0 24 19 26.3

Instructors 0 39 54 18 73 60 18 65 25 71 0 0 423 378 11.9

Participants 0 40 60 20 76 57 20 78 36 77 0 0 464 370 25.4

CLEAR

Courses 0 1 1 1 1 1 0 1 2 1 1 0 10 11 -9.1

Instructors 0 4 3 3 4 5 0 4 10 7 5 0 45 46 -2.2

Participants 0 32 16 18 15 31 0 17 53 32 9 0 223 304 -26.6

TIPS Instructor course

Courses 0 0 0 1 0 0 0 0 0 0 0 0 1 0 –

Instructors 0 0 0 8 0 0 0 0 0 0 0 0 8 0 –

Participants 0 0 0 14 0 0 0 0 0 0 0 0 14 0 –

TIPS Provider Course

Courses 0 1 2 1 1 0 1 0 1 2 1 0 10 10 0.0

Instructors 0 10 21 10 11 0 8 0 10 17 9 0 96 90 6.7

Participants 0 12 24 10 10 0 7 0 8 21 12 0 104 118 -11.9

OWR Instructor course

Courses 0 0 1 0 0 0 0 0 1 0 0 0 2 1 100.0

Instructors 0 0 7 0 0 0 0 0 5 0 0 0 12 7 71.4

Participants 0 0 10 0 0 0 0 0 9 0 0 0 19 10 90.0

OWR Provider Course

Courses 0 1 1 1 2 1 1 1 2 1 3 0 14 0 –

Instructors 0 5 3 7 10 5 6 4 10 5 15 0 70 0 –

Participants 0 18 17 16 52 17 14 20 36 22 44 0 256 0 –

Total

Courses 1 13 21 10 16 15 12 10 16 18 18 3 153 147 4.1

Instructors 9 140 228 105 181 175 125 114 156 201 160 34 1628 1641 -0.8

Participants 16 228 324 154 280 256 172 171 254 300 270 50 2475 2470 0.2

Note: Number of instructors documented in this table is not the number of individual instructors, but the number of times any member of the faculty taught a course.


85


SECTION 1: ACTIVITIES OF SKILLS TRAINING

TABLE ST.2 – Skills training course attendance by location and course

Course ACT NSW NT QLD SA TAS VIC WAAUS

Total NZ O/STotal 2017

Total 2016

% Change

16/17

CCrISP Instructor Course

Courses 0 0 0 0 0 0 2 0 2 0 0 2 3 -33.3

Instructors 0 0 0 0 0 0 15 0 15 0 0 15 21 -28.6

Participants 0 0 0 0 0 0 28 0 28 0 0 28 35 -20.0

CCrISP Provider Course

Courses 0 6 0 5 3 0 6 1 21 5 0 26 28 -7.1

Instructors 0 76 0 60 34 0 78 13 261 67 0 328 379 -13.5

Participants 0 92 0 74 42 0 94 16 318 79 0 397 433 -8.3

EMST ADF Course

Courses 0 4 0 0 0 0 0 0 4 0 0 4 4 0.0

Instructors 0 39 0 0 0 0 0 0 39 0 0 39 39 0.0

Participants 0 62 0 0 0 0 0 0 62 0 0 62 59 5.1

EMST Instructor Course

Courses 0 0 0 0 0 0 2 0 2 0 0 2 2 0.0

Instructors 0 0 0 0 0 0 16 0 16 0 0 16 15 6.7

Participants 0 0 0 0 0 0 29 0 29 0 0 29 31 -6.5

EMST Provider Course

Courses 1 15 0 10 4 1 4 3 38 9 5 52 63 -17.5

Instructors 11 148 0 99 39 10 41 30 378 87 52 517 604 -14.4

Participants 16 230 0 152 59 11 64 42 574 143 77 794 1017 -21.9

EMST Refresher Course

Courses 0 2 0 1 0 0 1 1 5 1 0 6 6 0.0

Instructors 0 20 0 10 0 0 10 10 50 9 0 59 62 -4.8

Participants 0 30 0 15 0 0 15 12 72 13 0 85 93 -8.6

ASSET

Courses 0 6 0 4 2 0 6 2 20 4 0 24 19 26.3

Instructors 0 110 0 70 30 0 113 29 352 71 0 423 378 11.9

Participants 0 120 0 79 40 0 121 40 400 64 0 464 370 25.4

CLEAR

Courses 0 3 0 1 0 0 3 0 7 3 0 10 11 -9.1

Instructors 0 14 0 4 0 0 15 0 33 12 0 45 46 -2.2

Participants 0 94 0 15 0 0 72 0 181 42 0 223 304 -26.6

TIPS Instructor course

Courses 0 0 0 0 0 0 1 0 1 0 0 1 0 –

Instructors 0 0 0 0 0 0 8 0 8 0 0 8 0 –

Participants 0 0 0 0 0 0 14 0 14 0 0 14 0 –

TIPS Provider Course

Courses 0 3 0 1 1 0 3 1 9 1 0 10 10 0.0

Instructors 0 27 0 8 10 0 31 11 87 9 0 96 90 6.7

Participants 0 29 0 7 10 0 34 12 92 12 0 104 118 -11.9

OWR Instructor course

Courses 0 0 0 1 0 0 1 0 2 0 0 2 1 100.0

Instructors 0 0 0 5 0 0 7 0 12 0 0 12 7 71.4

Participants 0 0 0 9 0 0 10 0 19 0 0 19 10 90.0

OWR Provider Course

Courses 1 3 0 2 1 0 4 1 12 2 0 14 0 –

Instructors 5 16 0 10 5 0 20 4 60 10 0 70 0 –

Participants 15 41 0 54 19 0 73 20 222 34 0 256 0 –

Total

Courses 2 42 0 25 11 1 33 9 123 25 5 153 147 4.1

Instructors 16 450 0 266 118 10 354 97 1311 265 52 1628 1641 -0.8

Participants 31 698 0 405 170 11 554 142 2011 387 77 2475 2470 0.2

Note: Number of instructors documented in this table is not the number of individual instructors, but the number of times any member of the faculty taught a course.


86



TABLE ST.3 – ASSET faculty by location and specialty

ACT NSW NT QLD SA TAS VIC WAAUS


Total 2016

CAR 0 1 0 3 1 0 3 2 10 2 0 12 12

GEN 1 46 0 24 13 6 47 9 146 28 2 176 164

NEU 0 1 0 4 1 0 0 1 7 0 0 7 7

ORT 1 19 0 11 2 0 16 2 51 23 0 74 74

OTO 0 5 0 4 2 0 0 4 15 7 1 23 20

PAE 0 4 0 0 1 1 1 1 8 4 0 12 11

PLA 1 6 0 6 3 0 9 1 26 4 0 30 26

URO 1 1 0 2 3 0 6 2 15 4 0 19 20

VAS 0 5 0 2 1 2 4 3 17 1 1 19 14

Sub Total 4 88 0 56 27 9 86 25 295 73 4 372 348

IMG 0 0 0 0 0 0 1 0 1 3 0 4 2

SET 0 0 0 0 0 0 6 1 7 1 0 8 7

Other 0 1 0 0 0 0 0 1 2 0 0 2 2

OPH 0 1 0 0 0 0 0 0 1 0 0 1 1

Total 4 90 0 56 27 9 93 27 306 77 4 387 360

TABLE ST.4 – CCrISP faculty by location and medical discipline



Total 2016

Anaesthesia 0 7 0 5 2 0 9 3 26 21 5 52 51

Emergency Medicine 3 1 0 5 4 1 4 2 20 0 0 20 26

General Practice 0 3 0 1 0 0 0 1 5 0 0 5 4

Intensive Care 2 10 0 5 1 2 3 4 27 3 0 30 29

Internal medicine 0 0 0 0 5 0 0 0 5 1 0 6 6

Surgery 1 30 1 33 9 5 33 17 129 41 13 183 175

Other 0 0 0 0 0 0 0 0 0 0 1 1 5

Total 6 51 1 49 21 8 49 27 212 66 19 297 296

TABLE ST.5 – EMST faculty by location and medical discipline



Total 2016

Anaesthesia 1 30 2 18 2 2 16 6 77 9 3 89 89



Intensive Care 1 7 1 12 6 1 12 1 41 4 1 46 48

Surgery 4 54 3 23 9 3 31 14 141 25 16 182 191

Other 0 2 0 0 1 0 0 0 3 2 0 5 3

Total 13 140 10 84 38 11 91 48 435 67 20 522 544

TABLE ST.6 – CCrISP and EMST attendance by location and pass rate

Course ACT NSW NT QLD SA TAS VIC WA AUS NZ OSTotal 2017

Total 2016

% Change

16/17

CCrISP

Attended 3 108 2 70 24 5 80 32 324 100 1 425 468 -9.2

Pass 2 100 2 62 24 5 75 29 299 98 0 397 457 -13.1

% Pass 67% 93% 100% 89% 100% 100% 94% 91% 92% 98% 0% 93% 98% -4.3

EMST

Attended 25 262 10 194 70 11 127 62 761 201 8 970 1200 -19.2

Pass 21 229 8 179 60 11 111 57 676 194 8 878 1084 -19.0

% Pass 84% 87% 80% 92% 86% 100% 87% 92% 89% 97% 100% 91% 90% 0.2


87

SECTION 1: ACTIVITIES OF SKILLS TRAINING


TABLE ST.7 – CLEAR faculty by location, specialty and medical discipline



Total 2016

CAR 0 1 0 0 0 0 1 0 2 1 0 3 3

GEN 0 3 0 1 0 3 0 2 9 2 0 11 7

NEU 0 1 0 0 0 0 0 0 1 0 0 1 2

ORT 0 3 0 1 0 0 0 0 4 2 0 6 5

OTO 0 0 0 0 0 0 0 0 0 0 0 0 0

PAE 0 0 0 0 0 0 0 0 0 1 0 1 1

PLA 0 0 0 0 0 0 1 0 1 0 0 1 1

URO 0 1 0 0 0 0 0 0 1 0 0 1 1

VAS 0 1 0 0 0 0 0 0 1 0 0 1 1

Sub Total 0 10 0 2 0 3 2 2 19 6 0 25 21

CLE 0 2 0 2 0 1 0 0 5 1 0 6 6

Total 0 12 0 4 0 4 2 2 24 7 0 31 27

TABLE ST.8 – TIPS faculty by location and medical discipline



Total 2016

Anaesthesia 0 1 0 0 1 0 0 0 2 0 0 2 2



Intensive Care 0 0 0 0 1 0 0 0 1 0 0 1 0

Physician 0 0 0 0 0 0 0 0 0 0 0 0 1

Surgery 0 9 0 6 8 0 8 1 32 9 0 41 32

Other 0 2 0 2 1 0 4 1 10 1 0 11 7

Total 0 12 0 10 11 0 14 2 49 10 0 59 46

TABLE ST.9 – OWR Faculty by region, specialty and medical discipline



Total 2016

CAR 0 0 0 0 0 0 0 0 0 1 0 1 0

GEN 0 1 0 3 1 1 3 0 9 2 0 11 0

NEU 0 1 0 1 0 0 1 0 3 0 0 3 0

ORT 0 0 0 0 0 0 1 0 1 1 0 2 0

OTO 0 1 0 1 0 0 0 0 2 0 0 2 0

PAE 0 0 0 1 0 0 0 0 1 2 0 3 0

PLA 0 0 0 0 0 0 0 0 0 0 0 0 0

URO 0 0 0 0 0 0 0 0 0 0 0 0 0

VAS 0 0 0 0 0 0 0 0 0 1 0 1 0

Sub Total 0 3 0 6 1 1 5 0 16 7 0 23 0

Intensive Care 1 0 0 0 0 0 0 0 1 0 0 1 0

Total 1 3 0 6 1 1 5 0 17 7 0 24 0


88


ACTIVITIES OF INTERNATIONAL MEDICAL GRADUATESSECTION TWO

EXPLANATORY NOTES – AustraliaThe processes for assessing the comparability of International Medical Graduates (IMGs) to holders of RACS Fellowship, and for practice as surgeons in Australia are in accordance with the principles outlined in the following publications:

• RACS – Specialist Assessment of International Medical Graduates in Australia policy https://www.surgeons.org/policies-publications/policies/international-medical-graduates/

• RACS – IMG Area of Need Assessment policy https://www.surgeons.org/policies-publications/policies/international-medical-graduates/

• Australian Medical Council (AMC) – Standards for Assessment and Accreditation of Specialist Medical Education Programs and Professional Development Programs by the AMC 2015 AMC Standards for Assessment

• Medical Board of Australia (MBA) Guidelines – Good practice guidelines for the specialist international medical graduate assessment process http://www.medicalboard.gov.au/Registration/International-Medical-Graduates/Specialist-Pathway.aspx

International Medical Graduates – Period of Clinical AssessmentThe process related to the period of clinical assessment for IMGs are in accordance with the principles outlined in the following publications:

• RACS Clinical Assessment of International Medical Graduates in Australia policy; https://www.surgeons.org/policies-publications/policies/international-medical-graduates/

and

• MBA Guidelines – Supervised practice for international medical graduates http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx

International Medical Graduates Short Term Training in a Medical Specialty PathwayShort-term training programs in Australia allow IMGs the opportunity to undertake a short-term training program not available in their country of training with the objective of improving their professional skills and experience. Within the surgical specialty, an IMG approved to undertake a short-term training position/program can develop surgical skills and experience through a work based surgical program provided by the hospital.

The process related to the short-term training program for IMGs are in accordance with the principles outlined in the following publications:

• Short Term Training in a Medical Specialty Pathway policy https://www.surgeons.org/policies-publications/policies/international-medical-graduates/

• MBA – Short Term Training in a Medical Specialty Pathway http://www.medicalboard.gov.au/Registration/International-Medical-Graduates/Short-term-training.aspx

EXPLANATORY NOTES – New ZealandIn New Zealand, RACS acts as an agent of, and provides recommendations to, the Medical Council of New Zealand (MCNZ) on applications by IMGs for vocational registration in one of RACS’ nine surgical specialties. The provision of preliminary advice, an interview or a review occurs only in response to a request from the MCNZ.

The MCNZ holds statutory responsibility for approving the standard for registration and requests that RACS advise whether an IMG’s training, qualifications and experience are equivalent to, or as satisfactory as, those of a locally trained doctor registered in the same vocational branch of surgery.

A recommendation on the IMG’s suitability for the vocational registration pathway is provided to the MCNZ to advise if the IMG is suitable for the pathway. The recommendation includes whether the IMG should be placed under MCNZ approved supervision, or receive College approved assessment to ensure the IMG is at the required standard. The MCNZ considers this and determines the type of medical registration that will be offered to the IMG and any restrictions or conditions that may be placed on that registration. The MCNZ advises RACS and the IMG of its decision.

If the IMG is required to undertake a RACS approved vocational assessment, RACS is asked to approve the post and the supervisor(s) and the supervisor’s reports are sent to RACS and to the MCNZ. Once all assessment requirements have been completed by the IMG, RACS recommends to the MCNZ if the IMG should be approved for inclusion on the vocational register in the relevant specialty.

Admission to Fellowship of the Royal Australasian College of Surgeons is a decision of the College alone and it is not part of the vocational registration assessments for the MCNZ. IMGs who have obtained vocational registration in New Zealand may apply to RACS for admission to Fellowship, and the information from the vocational registration process may be considered by RACS in reaching its decision on that application.


89

SECTION 2: ACTIVITIES OF INTERNATIONAL MEDICAL GRADUATES


AustraliaTABLE IMG.1 – Number of International Medical Graduate applications activated by specialty

Assessment result CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Specialist recognition 3 11 5 12 7 3 5 2 4 52

Area of need 0 2 0 4 0 0 2 1 0 9

Total 3 13 5 16 7 3 7 3 4 61

TABLE IMG.2 – International Medical Graduate countries of training

Qualification

Country a Primary SecondaryTotal 2017

Argentina 1 1 2

Armenia 1 1 2

Belgium 1 1 2

Brazil 2 2 4

Canada 1 0 1

China 1 0 1

Denmark 1 1 2

Egypt 1 1 2

France 1 1 2

Germany 1 1 2

India 16 13 29

Iran 1 0 1

Ireland 1 1 2

Malaysia 1 0 1

Pakistan 3 2 5

Philippines 1 1 2

Russia 1 1 2

Saudi Arabia 1 1 2

Scotland 1 0 1

Serbia 2 2 4

South Africa 3 1 4

Sri Lanka 1 1 2

South Korea 1 1 2

Turkey 1 1 2

United Kingdom 14 23 37

United States of America 1 3 4

Zimbabwe 1 1 2

Total 61 61 122a The country in which the IMG gained their qualification (primary qualification and specialist qualification).


90


ACTIVITIES OF INTERNATIONAL MEDICAL GRADUATESSECTION TWO

TABLE IMG.3 – Number of International Medical Graduates not comparable after initial paper based review

CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

No. of IMGs not comparable 0 2 2 1 1 0 2 1 1 10

Note: IMGs are subject to paper-based assessment only. Interview is not required.

TABLE IMG.4 – Number of applications withdrawn by International Medical Graduates


Before initial assessment 0 2 0 2 0 0 0 0 0 4

Between initial and final assessment 0 1 0 2 1 0 0 0 0 4

Total 0 3 0 4 1 0 0 0 0 8

Note: Number of IMGs who notify the college that they no longer wish to proceed with their application for specialist assessment

TABLE IMG.5 – Specialist assessment pathway: International Medical Graduate outcome of initial assessment Outcome following the college’s paper-based review and/or interview as documented in Medical Board of Australia Report 1


Substantially comparable 0 6 0 0 5 0 0 1 0 12

Partially comparable 1 2 3 8 1 2 4 0 2 23

Not comparable 2 3 3 4 5 1 4 2 1 25

In progress 0 2 0 2 2 0 0 1 1 8

Total 3 13 6 14 13 3 8 4 4 68

Application incomplete as at 31/12/2017

0 0 0 0 0 0 0 0 0 0

Applications activated and processed in 2017

3 9 5 10 5 3 5 1 3 44

Total processed 3 9 5 10 5 3 5 1 3 44

Note: If IMG’s comparability is based on a limited scope of practice this should be noted.


91



TABLE IMG.6 – Specialist assessment pathway: International Medical Graduate specialists under oversight / supervision

Clinical assessment – by specialty

Supervision/oversight period CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Currently under oversight≤ 12 months 0 2 0 0 3 1 0 0 0 6

≤ 24 months 0 2 0 0 0 0 0 0 0 2

Currently under supervision≤ 12 months 0 3 0 2 3 0 0 0 0 8

≤ 24 months 1 6 3 13 2 0 2 3 0 30

Completed oversight/supervision 1 4 0 7 2 0 2 0 2 18

Total 2 17 3 22 10 1 4 3 2 64

Clinical assessment – by location of residence

Supervision/oversight period ACT NSW NT QLD SA TAS VIC WAAUS

Total NZTotal 2017

Currently under oversight≤ 12 months 0 2 0 0 0 0 3 0 5 1 6

≤ 24 months 0 0 0 0 0 0 2 0 2 0 2

Currently under supervision≤ 12 months 0 0 1 1 2 0 4 0 8 0 8

≤ 24 months 2 10 0 7 3 0 6 2 30 0 30

Completed oversight/supervision 0 2 1 6 1 0 5 3 18 0 18

Total 2 14 2 14 6 0 20 5 63 1 64

TABLE IMG.7 – Area of need pathway: International Medical Graduate outcome of initial assessmentOutcome following the college’s paper-based review and/or interview as documented in Medical Board of Australia Report 1




Not comparable 0 1 0 1 0 0 0 1 0 3

In progress 0 0 0 0 0 0 0 0 0 0

Total 0 2 0 4 0 0 2 1 0 9

Application incomplete as at 31/12/2017

0 0 0 0 0 0 0 0 0 0

Applications activated and processed in 2017

0 2 0 4 0 0 2 1 0 9

Total processed 0 2 0 4 0 0 2 1 0 9


92

SECTION TWO ACTIVITIES OF INTERNATIONAL MEDICAL GRADUATES


TABLE IMG.8 – Area of need pathway: International Medical Graduate specialists under oversight / supervisionn

Clinical assessment – by specialty

Supervision/oversight period CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Currently under oversight≤ 12 months 0 0 0 0 0 0 0 0 0 0

≤ 24 months 0 0 0 2 0 0 0 0 0 2

Currently under supervision≤ 12 months 0 0 0 0 1 0 0 0 0 1

≤ 24 months 0 0 0 1 2 0 1 0 0 4

Completed oversight/supervision 0 0 0 2 1 0 1 1 0 5

Total 0 0 0 5 4 0 2 1 0 12

Clinical assessment – by location of residence

Supervision/oversight period ACT NSW NT QLD SA TAS VIC WAAUS

Total NZTotal 2017

Currently under oversight≤ 12 months 0 0 0 0 0 0 0 0 0 0 0

≤ 24 months 0 0 0 1 0 0 1 0 2 0 2

Currently under supervision≤ 12 months 0 1 0 0 0 0 0 0 1 0 1

≤ 24 months 0 0 1 0 0 2 0 1 4 0 4

Completed oversight/supervision 0 0 0 1 0 2 2 0 5 0 5

Total 0 1 1 2 0 4 3 1 12 0 12

TABLE IMG.9 – International Medical Graduate outcome of area of need assessmentOutcome following the college’s paper-based review as documented in area of need assessment outcome report or Medical Board of Australia (MBA) Report combined report.


Suitable for area of need position 0 1 0 3 0 0 2 0 0 6

Not suitable for area of need position 0 1 0 1 0 0 0 1 0 3

Total 0 2 0 4 0 0 2 1 0 9

TABLE IMG.10 – International Medical Graduate outcome of final assessmentOutcome following the college’s final assessment (after the IMG has completed all the requirements in MBA report 1) as documented in Medical Board of Australia Report 2.


Recommended for recognition as specialist



Not recommended for recognition as specialist



Total 2 13 1 14 3 2 1 2 2 40

Note: If IMGs comparability is based on a limited scope of practice this should be noted.


93



TABLE IMG.11 – International Medical Graduate time for specialist recognition initial assessment

2017

0-3 months 19

4-6 months 22

7-9 months 3

9 months + 0

Total 44

Note: As documented in Medical Board of Australia Report 1.

TABLE IMG.12 – International Medical Graduate time for area of need assessment

2017

0-3 months 3

4-6 months 6

7-9 months 0

9 months + 0

Total 9

Note: As documented in Medical Board of Australia Report 1.

TABLE IMG.13 – International Medical Graduate time for specialist recognition final assessment

2017

0-3 months 0

4-6 months 0

7-12 months 1

13-18 months 11

19-24 months 1

24 months + 12

Total 25

Note: Timeframe to complete all requirements as specified in specialist recommendation. Period is noted from date of commencement of clinical assessment. As documented in Medical Board of Australia Report 2.

TABLE IMG.14 – International Medical Graduate – number and outcome of appeal

Total number of appeals 2017

Decision being appealedOutcome of initial assessment 0

Outcome of final assessment 0

Original decisionNot comparable 0

Partially comparable 0

RACS decisionUpheld 0

Overturned 0


94

SECTION TWO ACTIVITIES OF INTERNATIONAL MEDICAL GRADUATES


TABLE IMG.15 – Short-term specified training: International Medical Graduate specialist applications by specialty

RACS decision CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Approved 30 26 14 92 18 5 22 14 8 229

Denied 1 1 1 1 0 0 0 0 0 4

Pending 0 3 0 7 0 0 1 1 0 12

Total 31 30 15 100 18 5 23 15 8 245

TABLE IMG.16 – Short-term specified training: International Medical Graduate specialist applications by location

RACS decision ACT NSW NT QLD SA TAS VIC WAAUS

Total NZTotal 2017

Approved 1 91 4 35 27 2 48 21 229 0 229

Denied 0 2 1 0 0 0 1 0 4 0 4

Pending 0 8 0 1 0 0 2 1 12 0 12

Total 1 101 5 36 27 2 51 22 245 0 245

TABLE IMG.17 – Number of International Medical Graduate specialists practising in Australia

Total 2017

Total number of IMGs practicing in Australia with valid assessment 76

Note: IMGs undergoing clinical assessment or IMGs who have completed clinical assessment and are required to complete the College’s Fellowship Examination and/or other requirements as stipulated in their specialist recommendation following a document based assessment and interview.

New ZealandTABLE IMG.18 – Applications for International Medical Graduate specialists

Preliminary advice to the MCNZ following documentation review CAR GEN NEU ORT OTO PAE PLA URO VAS

Total 2017

Likely to be suitable for vocational pathway 1 1 0 3 3 0 1 1 0 10

Unlikely to be suitable for vocational pathway 0 2 0 2 2 1 0 0 0 7

Unable to determine suitability by documentation only 0 1 0 4 1 0 2 0 1 9

Preliminary advise requests not yet completed 0 1 0 0 0 0 0 0 0 1

Total 1 5 0 9 6 1 3 1 1 27

TABLE IMG.19 – Interview outcomes for International Medical Graduate specialists applicants

Advice to MCNZ following interview CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Vocational pathway – supervision (MCNZ approved) 0 5 0 1 2 2 0 1 1 12

Vocational pathway – supervised assessment (College approved)

0 0 1 3 1 1 1 0 0 7

Not suitable for vocational pathway 0 2 0 0 2 1 2 0 2 9

Total 0 7 1 4 5 4 3 1 3 28

Applications yet to achieve interview completion CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Applicants awaiting interviews at end of December 2017 0 0 0 0 0 0 0 0 0 0

Interview process incomplete at end of December 2017 1 0 1 2 1 0 0 0 0 5

Application(s) withdrawn prior to interview 2017 0 0 0 0 0 0 0 0 0 0

Total 1 0 1 2 1 0 0 0 0 5


95



TABLE IMG.20 – International Medical Graduate specialists participating in vocational assessment

IMGs under College approved vocational assessment in 2017 CAR GEN NEU ORT OTO PAE PLA URO VAS

Total 2017

For full scope registration 0 3 0 5 0 0 0 0 0 8

For restricted scope registration 0 0 0 0 0 0 0 0 0 0

Total 0 3 0 5 0 0 0 0 0 8

College approved vocational assessments completed in 2017 CAR GEN NEU ORT OTO PAE PLA URO VAS

Total 2017

To satisfactory standard 1 0 0 0 1 0 0 0 0 2

Not to satisfactory standard 0 0 0 0 0 0 1 0 0 1

Withdrawn from program 0 0 0 1 0 0 0 0 0 1

Total 1 0 0 1 1 0 1 0 0 4

TABLE IMG.21 – RACS review of recommendations for International Medical Graduate specialist applicants at the request of the Medical Council of New Zealand

RACS recommendation after review CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Recommendation altered 0 0 0 0 0 0 0 0 0 0

Recommendation not altered 0 0 0 1 2 0 0 0 0 3

In progress 0 0 0 1 0 0 0 0 0 1

Total 0 0 0 2 2 0 0 0 0 4

MCNZ decision of RACS review CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

RACS review accepted by MCNZ 0 0 0 1 1 0 0 0 0 2

RACS review not accepted by MCNZ 0 0 0 0 1 0 0 0 0 1

In progress 0 0 0 1 0 0 0 0 0 1

Total 0 0 0 2 2 0 0 0 0 4


96


ACTIVITIES OF SURGICAL EDUCATION & TRAININGSECTION THREE

EXPLANATORY NOTESThe College is accredited to conduct surgical training in nine specialties. The following specialties conduct bi-national training programs:

• Cardiothoracic Surgery

• Neurosurgery

• Paediatric Surgery

• Urology Surgery; and

• Vascular Surgery.

Separate programs are conducted in Australia and New Zealand for the following specialties:

• General Surgery

• Orthopaedic Surgery

• Otolaryngology – Head and Neck Surgery; and

• Plastic and Reconstructive Surgery.

The number of appointments made in any year is dependent on the number of Trainees finishing the program and the consequent number of vacant accredited posts. The College does not control the number of posts available but accredits posts nominated by jurisdictions. RACS has committed to accrediting any training post that meets the accreditation standards.

Since the introduction of the SET program in 2008 individual specialties have diverged from a common categorisation of Trainee SET level. Consequently this report is based on ‘years in training’ and doesn’t reflect individual Trainees’ progress towards Fellowship.

The Australian Orthopaedic Association has not notified RACS of the regional or person type breakdown of applications received for the orthopaedic program in Australia. The totals listed in tables SET.1 to SET.4 have been included as Australian applicants only with no regional breakdown and included as Non IMG/Trainees. Also, it is unclear whether applicants to the orthopaedic program in Australia made applications to other specialties (table SET.3).

Active Trainees who started training, finished training or admitted to Fellowship in the middle of the year are counted as an active Trainee in all tables.

DATA SUMMARYSET applications increased in 2017 by almost 6%, and Cardiothoracic Surgery had the largest increase in applications compared to 2016 (64%). The number of individual female SET applicants increased by 10%, and comprised almost one-third of all individual applicants (Table SET.3). There were 255 applicants who were offered a Trainee position in 2017. Just over 30% of successful applicants were female, a 6% increase from 2016 (Table SET.5).


97

SECTION 3: ACTIVITIES OF SURGICAL EDUCATION & TRAINING


TABLE SET.1 – SET applications by specialty and applicant typea

SET IMGNON IMG/

Traineeb FellowTotal 2017

Total 2016

% Change 16/17

CAR

Male 2 0 30 1 33 19 73.7

Female 2 0 11 0 13 9 44.4

Total 4 0 41 1 46 28 64.3

GEN

Male 0 0 180 0 180 163 10.4

Female 0 0 97 0 97 88 10.2

Total 0 0 277 0 277 251 10.4

NEU

Male 0 0 34 0 34 39 -12.8

Female 1 0 14 0 15 16 -6.3

Total 1 0 48 0 49 55 -10.9

ORTC

Male 0 0 191 0 191 158 20.9

Female 0 0 34 0 34 23 47.8

Total 0 0 225 0 225 181 24.3

OTO

Male 4 0 53 0 57 62 -8.1

Female 1 0 22 0 23 36 -36.1

Total 5 0 75 0 80 98 -18.4

PAE

Male 1 0 9 0 10 11 -9.1

Female 1 0 13 0 14 5 180.0

Total 2 0 22 0 24 16 50.0

PLA

Male 3 0 44 0 47 58 -19.0

Female 0 0 31 0 31 35 -11.4

Total 3 0 75 0 78 93 -16.1

URO

Male 5 0 44 0 49 60 -18.3

Female 1 0 12 0 13 18 -27.8

Total 6 0 56 0 62 78 -20.5

VAS

Male 5 0 26 0 31 31 0.0

Female 1 0 16 0 17 11 54.5

Total 6 0 42 0 48 42 14.3

Total

Male 20 0 611 1 632 601 5.2

Female 7 0 250 0 257 241 6.6

Total 27 0 861 1 889 842 5.6

a Total number of SET applications may include more than one application from an individual.b Non-IMG/Trainee refers to applications from those not currently Fellows, Trainees or IMGs.


98

SECTION THREE ACTIVITIES OF SURGICAL EDUCATION & TRAINING


TABLE SET.2 – SET applications by specialty and location of residencea



Total 2016

% Change

16/17

CAR

Male 0 12 0 5 2 0 8 1 28 5 0 33 19 73.7

Female 0 6 0 2 0 0 4 0 12 1 0 13 9 44.4

Total 0 18 0 7 2 0 12 1 40 6 0 46 28 64.3

GEN

Male 5 51 3 44 10 0 37 14 164 15 1 180 163 10.4

Female 5 24 0 16 5 0 23 11 84 13 0 97 88 10.2

Total 10 75 3 60 15 0 60 25 248 28 1 277 251 10.4

NEU

Male 1 11 0 5 1 1 7 3 29 4 1 34 39 -12.8

Female 0 2 0 5 2 0 4 0 13 2 0 15 16 -6.3

Total 1 13 0 10 3 1 11 3 42 6 1 49 55 -10.9

ORTb

Male 1 58 1 55 8 1 35 12 171 20 0 191 158 20.9

Female 1 10 0 7 4 0 7 0 29 5 0 34 23 47.8

Total 2 68 1 62 12 1 42 12 200 25 0 225 181 24.3

OTO

Male 1 16 0 10 6 0 16 3 52 5 0 57 62 -8.1

Female 0 3 0 6 1 0 5 1 16 7 0 23 36 -36.1

Total 1 19 0 16 7 0 21 4 68 12 0 80 98 -18.4

PAE

Male 1 3 0 2 1 0 1 1 9 1 0 10 11 -9.1

Female 0 3 0 4 0 1 2 0 10 4 0 14 5 180.0

Total 1 6 0 6 1 1 3 1 19 5 0 24 16 50.0

PLA

Male 2 12 0 7 4 0 12 3 40 7 0 47 58 -19.0

Female 2 4 0 3 2 0 8 2 21 10 0 31 35 -11.4

Total 4 16 0 10 6 0 20 5 61 17 0 78 93 -16.1

URO

Male 2 12 2 8 1 0 17 4 46 3 0 49 60 -18.3

Female 0 1 0 6 1 0 4 0 12 1 0 13 18 -27.8

Total 2 13 2 14 2 0 21 4 58 4 0 62 78 -20.5

VAS

Male 1 8 0 5 3 0 7 2 26 5 0 31 31 0.0

Female 1 4 0 2 0 0 4 3 14 3 0 17 11 54.5

Total 2 12 0 7 3 0 11 5 40 8 0 48 42 14.3

Total

Male 13 125 5 86 28 1 105 31 565 65 2 632 601 5.2

Female 8 47 0 44 11 1 54 17 211 46 0 257 241 6.6

Total 21 172 5 130 39 2 159 48 776 111 2 889 842 5.6

a Total number of SET applications may include more than one application from an individual.


99



TABLE SET.3 – Individual SET applicants by number of applications and applicant typea

No. of applications SET SET Deferred IMG

NON IMG/ Trainee Fellow

Total 2017

Total 2016

% Change

16/17

1

Male 18 0 0 368 1 387 396 -2.3

Female 7 0 0 187 0 194 169 14.8

Total 25 0 0 555 1 581 565 2.8

2

Male 1 0 0 48 0 49 51 -3.9

Female 0 0 0 21 0 21 22 -4.5

Total 1 0 0 69 0 70 73 -4.1

3

Male 0 0 0 4 0 4 2 100.0

Female 0 0 0 0 0 0 4 -100.0

Total 0 0 0 4 0 4 6 -33.3

≥4

Male 0 0 0 0 0 0 0 –

Female 0 0 0 0 0 0 0 –

Total 0 0 0 0 0 0 0 –

Total

Male 19 0 0 420 1 440 449 -2.0

Female 7 0 0 208 0 215 195 10.3

Total 26 0 0 628 1 655 644 1.7

a The total number of applicants to the Australian Orthopaedic SET program are included as single (1) applications only; it is unknown if these applicants also applied to other SET programs, therefore some applicants may be recorded more than once.

TABLE SET.4 – SET applications outcome by specialty and applicant type

Offersa Unsuccessful Waiting List Withdrawn Ineligible Declined

Specialty No. % No. % No. % No. % No. % No. %Total

2017b

CAR 8 17.4 38 82.6 0 0.0 0 0.0 0 0.0 0 0.0 46

GEN 105 37.9 165 59.6 0 0.0 0 0.0 0 0.0 7 2.5 277

NEU 8 16.3 41 83.7 0 0.0 0 0.0 0 0.0 0 0.0 49

ORT 56 24.8 170 75.2 0 0.0 0 0.0 0 0.0 0 0.0 226

OTO 25 31.3 55 68.8 0 0.0 0 0.0 0 0.0 0 0.0 80

PAE 4 16.7 19 79.2 0 0.0 0 0.0 0 0.0 1 4.2 24

PLA 20 25.6 58 74.4 0 0.0 0 0.0 0 0.0 0 0.0 78

URO 22 35.5 40 64.5 0 0.0 0 0.0 0 0.0 0 0.0 62

VAS 8 16.7 39 81.3 0 0.0 1 2.1 0 0.0 0 0.0 48

Total 256 28.8 625 70.2 0 0.0 1 0.1 0 0.0 8 0.9 890

Applicant type

SET 9 33.3 12 44.4 0 0.0 0 0.0 0 0.0 6 22.2 27

Fellow 0 – 0 – 0 – – 0 – 0 – 0

Non IMGTrainee 247 28.6 613 71.0 0 0.0 1 0.1 0 0.0 2 0.2 863

Totalb 256 28.8 625 70.2 0 0.0 1 0.1 0 0.0 8 0.9 890

a Includes deferred applications b Totals do not include declined applications as they were subsequently offered to other applicants and reflected in the Offers column.


100



TABLE SET.5 – Successful SET application by specialty and location of residence



Total 2016

CAR

Male 0 3 0 0 0 0 1 0 4 1 0 5 5

Female 0 2 0 0 0 0 1 0 3 0 0 3 1

Total 0 5 0 0 0 0 2 0 7 1 0 8 6

GEN

Male 2 19 2 14 2 0 17 4 60 7 1 68 73

Female 1 8 0 8 2 0 8 2 29 8 0 37 33

Total 3 27 2 22 4 0 25 6 89 15 1 105 106

NEU

Male 0 0 0 1 0 0 1 1 3 0 0 3 11

Female 0 0 0 2 1 0 2 0 5 0 0 5 0

Total 0 0 0 3 1 0 3 1 8 0 0 8 11

ORT

Male 0 12 0 11 1 0 13 1 38 8 0 46 52

Female 0 3 0 0 2 0 3 0 8 2 0 10 3

Total 0 15 0 11 3 0 16 1 46 10 0 56 55

OTO

Male 0 6 0 5 4 0 1 1 17 2 0 19 11

Female 0 1 0 1 0 0 2 0 4 2 0 6 6

Total 0 7 0 6 4 0 3 1 21 4 0 25 17

PAE

Male 1 0 0 0 0 0 0 0 1 0 0 1 4

Female 0 2 0 1 0 0 0 0 3 0 0 3 3

Total 1 2 0 1 0 0 0 0 4 0 0 4 7

PLA

Male 0 3 0 3 3 0 1 2 12 1 0 13 15

Female 0 2 0 0 0 0 1 2 5 2 0 7 9

Total 0 5 0 3 3 0 2 4 17 3 0 20 24

URO

Male 1 3 1 4 0 0 8 0 17 2 0 19 11

Female 0 1 0 1 0 0 1 0 3 0 0 3 5

Total 1 4 1 5 0 0 9 0 20 2 0 22 16

VAS

Male 0 0 0 0 2 0 0 1 3 1 0 4 8

Female 0 1 0 1 0 0 1 0 3 1 0 4 2

Total 0 1 0 1 2 0 1 1 6 2 0 8 10

Total

Male 4 46 3 38 12 0 42 10 155 22 1 178 190

Female 1 20 0 14 5 0 19 4 63 15 0 78 62

Total 5 66 3 52 17 0 61 14 218 37 1 256 252


101



TABLE SET.6 – Active SET Trainees by status and training locationa

Trainee status ACT NSW NT QLD SA TAS VIC WAAUS


Total 2016

% Change

16/17

Clinical

Male 11 252 7 127 51 13 180 67 708 126 1 835 800 4.4

Female 6 87 3 46 19 6 73 19 259 41 0 300 309 -2.9

Total 17 339 10 173 70 19 253 86 967 167 1 1135 1109 2.3

Accredited Research

Male 0 0 0 0 0 0 0 0 0 0 0 0 1 -100.0

Female 0 0 0 0 0 0 0 1 1 0 0 1 0 –

Total 0 0 0 0 0 0 0 1 1 0 0 1 1 0.0

Part Time

Male 0 0 0 0 0 0 0 0 0 0 0 0 1 -100.0

Female 0 0 0 4 1 0 0 0 5 0 0 5 3 66.7

Total 0 0 0 4 1 0 0 0 5 0 0 5 4 25.0

Probationary

Male 0 1 0 1 0 0 4 0 6 0 0 6 12 -50.0

Female 0 3 0 2 1 0 2 0 8 2 0 10 6 66.7

Total 0 4 0 3 1 0 6 0 14 2 0 16 18 -11.1

Exam Pending

Male 0 3 0 0 2 0 2 1 8 3 0 11 23 -52.2

Female 0 3 0 0 0 0 0 0 3 0 0 3 8 -62.5

Total 0 6 0 0 2 0 2 1 11 3 0 14 31 -54.8

Total

Male 11 256 7 128 53 13 186 68 722 129 1 852 837 1.8

Female 6 93 3 52 21 6 75 20 276 43 0 319 326 -2.1

Total 17 349 10 180 74 19 261 88 998 172 1 1171 1163 0.7

a Total data cannot be verified as Australian Orthopaedic Association do not routinely report individual Australian Orthopaedic trainee data to RACS.

TABLE SET.7 – Inactive SET Trainees by status and training locationa

Trainee status ACT NSW NT QLD SA TAS VIC WAAUS


Total 2016

% Change

16/17

Approved interruption to training

Male 1 4 1 3 5 0 4 1 19 7 0 26 25 4.0

Female 1 14 0 4 0 2 4 1 26 11 0 37 32 15.6

Total 2 18 1 7 5 2 8 2 45 18 0 63 57 10.5

Deferred

Male 0 2 0 1 1 1 1 0 6 2 0 8 13 -38.5

Female 0 1 0 1 1 0 0 0 3 1 0 4 2 100.0

Total 0 3 0 2 2 1 1 0 9 3 0 12 15 -20.0

Suspended

Male 0 0 0 0 0 0 0 0 0 0 0 0 0 –

Female 0 0 0 0 0 0 0 0 0 1 0 1 0 –

Total 0 0 0 0 0 0 0 0 0 1 0 1 0 –

Total

Male 1 6 1 4 6 1 5 1 25 9 0 34 38 -10.5

Female 1 15 0 5 1 2 4 1 29 13 0 42 34 23.5

Total 2 21 1 9 7 3 9 2 54 22 0 76 72 5.6



102



TABLE SET.8 – Active SET Trainees by status and specialtya

Trainee status CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Total 2016

% Change

16/17

Clinical

Male 31 277 35 247 56 14 65 75 35 835 800 4.4

Female 6 148 11 33 25 17 26 23 11 300 309 -2.9

Total 37 425 46 280 81 31 91 98 46 1135 1109 2.3

Accredited Research

Male 0 0 0 0 0 0 0 0 0 0 1 -100.0

Female 1 0 0 0 0 0 0 0 0 1 0 –

Total 1 0 0 0 0 0 0 0 0 1 1 0.0

Part Time

Male 0 0 0 0 0 0 0 0 0 0 1 -100.0

Female 0 5 0 0 0 0 0 0 0 5 3 66.7

Total 0 5 0 0 0 0 0 0 0 5 4 25.0

Probationary

Male 0 0 1 0 2 0 1 2 0 6 12 -50.0

Female 1 0 1 0 2 0 4 2 0 10 6 66.7

Total 1 0 2 0 4 0 5 4 0 16 18 -11.1

Exam Pending

Male 2 2 0 3 0 0 3 0 1 11 23 -52.2

Female 0 2 0 0 1 0 0 0 0 3 8 -62.5

Total 2 4 0 3 1 0 3 0 1 14 31 -54.8

Total

Male 33 279 36 250 58 14 69 77 36 852 837 1.8

Female 8 155 12 33 28 17 30 25 11 319 326 -2.1

Total 41 434 48 283 86 31 99 102 47 1171 1163 0.7


TABLE SET.9 – Inactive SET Trainees by status and specialtya

Trainee status CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Total 2016

% Change

16/17

Approved Interruption to training

Male 0 15 4 0 2 2 1 1 1 26 25 4.0

Female 0 22 1 1 3 3 5 2 0 37 32 15.6

Total 0 37 5 1 5 5 6 3 1 63 57 10.5

Deferred

Male 0 4 0 0 1 0 1 1 1 8 13 -38.5

Female 0 0 0 0 1 0 2 1 0 4 2 100.0

Total 0 4 0 0 2 0 3 2 1 12 15 -20.0

SuspendedMale 0 0 0 0 0 0 0 0 0 0 0 –

Female 0 0 0 0 0 0 1 0 0 1 0 –

Total 0 0 0 0 0 0 1 0 0 1 0 –

Total

Male 0 19 4 0 3 2 2 2 2 34 38 -10.5

Female 0 22 1 1 4 3 8 3 0 42 34 23.5

Total 0 41 5 1 7 5 10 5 2 76 72 5.6



103



TABLE SET.10 – SET Trainees that exited the SET program, by specialtya

Terminated from SET Withdrawn from SET Other Total

Specialty Male Female Male Female Male Female Male Female

CAR 0 1 0 0 0 0 0 1

GEN 3 0 4 4 0 0 7 4

NEU 0 0 0 0 0 0 0 0

ORT 3 0 0 1 0 0 3 1

OTO 1 0 1 2 1 0 3 2

PAE 0 0 0 0 0 0 0 0

PLA 0 1 0 0 0 0 0 1

URO 0 0 1 0 1 0 2 0

VAS 0 0 0 0 0 0 0 0

Total 7 2 6 7 2 0 15 9

a Trainees that exited SET have not been counted as active trainees in table SET.6 & 8.

TABLE SET.11 – SET Trainees that exited the SET program, by year of traininga


Year Male Female Male Female Male Female Male Female

Year 1 0 0 2 3 0 0 2 3

Year 2 0 1 1 3 0 0 1 4

Year 3 3 1 0 0 1 0 4 1

Year 4 1 0 1 0 0 0 2 0

Year 5 2 0 1 0 0 0 3 0

Year 6+ 1 0 1 1 1 0 3 1

Total 7 2 6 7 2 0 15 9

a Trainees that exited SET have not been counted as active trainees in table SET.6 & 8. TABLE SET.12 – SET Trainees that exited the SET program, by regiona


Region Male Female Male Female Male Female Male Female

ACT 0 0 0 0 0 0 0 0

NSW 4 1 1 2 1 0 6 3

NT 0 0 0 0 0 0 0 0

QLD 1 0 1 0 0 0 2 0

SA 1 0 0 0 0 0 1 0

TAS 0 0 0 0 0 0 0 0

VIC 1 1 2 1 0 0 3 2

WA 0 0 0 2 1 0 1 2

AUS 7 2 4 5 2 0 13 7

NZ 0 0 2 2 0 0 2 2

O/S 0 0 0 0 0 0 0 0

Total 7 2 6 7 2 0 15 9

a Trainees that exited SET have not been counted as active trainees in table SET.6 & 8.


104



TABLE SET.13 – Active SET Trainees by age and location of training posta,b

Age group ACT NSW NT QLD SA TAS VIC WAAUS


<35

Male 6 124 6 63 34 7 105 30 375 79 1 455

Female 3 44 2 21 8 4 41 18 141 27 0 168

Total 9 168 8 84 42 11 146 48 516 106 1 623

35 – 39

Male 5 95 1 49 14 5 61 26 256 37 0 293

Female 3 36 1 26 10 2 28 1 107 15 0 122

Total 8 131 2 75 24 7 89 27 363 52 0 415

40 – 44

Male 0 30 0 14 3 1 17 11 76 10 0 86

Female 0 9 0 5 3 0 5 1 23 1 0 24

Total 0 39 0 19 6 1 22 12 99 11 0 110

45 – 49

Male 0 5 0 2 1 0 2 1 11 2 0 13

Female 0 4 0 0 0 0 1 0 5 0 0 5

Total 0 9 0 2 1 0 3 1 16 2 0 18

50 – 54

Male 0 2 0 0 1 0 1 0 4 1 0 5

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 2 0 0 1 0 1 0 4 1 0 5

55+

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 0 0 0 0 0 0 0 0 0 0 0

Total

Male 11 256 7 128 53 13 186 68 722 129 1 852

Female 6 93 3 52 21 6 75 20 276 43 0 319

Total 17 349 10 180 74 19 261 88 998 172 1 1171

a Total data cannot be verified as Australian Orthopaedic Association do not routinely report individual Australian Orthopaedic trainee data to RACS. Includes Trainees who started training /finished training/admitted to Fellowship in the middle of the year.

TABLE SET.14 – Active SET Trainees by age and specialtya,b

Age group CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

<35

Male 22 145 24 127 29 10 29 46 23 455

Female 5 75 6 21 13 9 16 16 7 168

Total 27 220 30 148 42 19 45 62 30 623

35 – 39

Male 6 95 10 91 26 3 28 24 10 293

Female 3 64 5 9 11 6 12 9 3 122

Total 9 159 15 100 37 9 40 33 13 415

40 – 44

Male 2 33 2 29 2 1 11 5 1 86

Female 0 12 1 3 4 1 2 0 1 24

Total 2 45 3 32 6 2 13 5 2 110

45 – 49

Male 1 4 0 3 1 0 1 2 1 13

Female 0 4 0 0 0 1 0 0 0 5

Total 1 8 0 3 1 1 1 2 1 18

50 – 54

Male 2 2 0 0 0 0 0 0 1 5

Female 0 0 0 0 0 0 0 0 0 0

Total 2 2 0 0 0 0 0 0 1 5

55+

Male 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0

Total 0 0 0 0 0 0 0 0 0 0

Total

Male 33 279 36 250 58 14 69 77 36 852

Female 8 155 12 33 28 17 30 25 11 319

Total 41 434 48 283 86 31 99 102 47 1171

a Total data cannot be verified as Australian Orthopaedic Association do not routinely report individual Australian Orthopaedic trainee data to RACS. b Includes Trainees who started training /finished training/admitted to Fellowship in the middle of the year.


105



TABLE SET.15 – Active SET Trainees by years in training and training post locationa,b



Total 2016

% Change

16/17

1 Year

Male 4 57 3 29 17 4 32 13 159 36 0 195 159

Female 1 13 1 11 3 1 10 7 47 8 0 55 68

Total 5 70 4 40 20 5 42 20 206 44 0 250 227 10.1

2 Years

Male 2 41 2 24 11 3 36 13 132 22 0 154 141

Female 2 20 1 4 3 3 18 3 54 16 0 70 48

Total 4 61 3 28 14 6 54 16 186 38 0 224 189 18.5

3 Years

Male 1 40 1 17 6 3 29 14 111 24 0 135 162

Female 0 15 1 6 3 1 8 3 37 6 0 43 68

Total 1 55 2 23 9 4 37 17 148 30 0 178 230 -22.6

4 Years

Male 2 49 0 24 10 1 39 13 138 25 0 163 163

Female 0 15 0 16 3 1 19 4 58 5 0 63 53

Total 2 64 0 40 13 2 58 17 196 30 0 226 216 4.6

5 Years

Male 2 49 1 29 7 2 38 13 141 17 1 159 164

Female 3 15 0 7 5 0 12 2 44 6 0 50 66

Total 5 64 1 36 12 2 50 15 185 23 1 209 230 -9.1

≥ 6 Years

Male 0 20 0 5 2 0 12 2 41 5 0 46 48

Female 0 15 0 8 4 0 8 1 36 2 0 38 23

Total 0 35 0 13 6 0 20 3 77 7 0 84 71 18.3

Total

Male 11 256 7 128 53 13 186 68 722 129 1 852 837

Female 6 93 3 52 21 6 75 20 276 43 0 319 326

Total 17 349 10 180 74 19 261 88 998 172 1 1171 1163 0.7

a Total data cannot be verified as Australian Orthopaedic Association do not routinely report individual Australian Orthopaedic trainee data to RACS. b Includes Trainees who started training /finished training/admitted to Fellowship in the middle of the year.

TABLE SET.16 – Active Cardiothoracic SET Trainees by years in training and training post location



Total 2016

% Change

16/17

1 Year

Male 0 2 0 0 1 0 2 0 5 1 0 6 6

Female 0 1 0 0 0 0 0 0 1 0 0 1 3

Total 0 3 0 0 1 0 2 0 6 1 0 7 9 -22.2

2 Years

Male 0 1 0 3 0 1 0 1 6 0 0 6 5

Female 0 0 0 0 0 0 1 1 2 0 0 2 2

Total 0 1 0 3 0 1 1 2 8 0 0 8 7 14.3

3 Years

Male 0 1 0 0 0 0 3 0 4 0 0 4 3

Female 0 0 0 0 1 0 0 0 1 1 0 2 2

Total 0 1 0 0 1 0 3 0 5 1 0 6 5 20.0

4 Years

Male 0 2 0 0 0 0 0 0 2 1 0 3 11

Female 0 0 0 0 0 0 1 0 1 1 0 2 1

Total 0 2 0 0 0 0 1 0 3 2 0 5 12 -58.3

5 Years

Male 0 2 0 2 0 0 4 0 8 1 1 10 3

Female 0 0 0 0 0 0 1 0 1 0 0 1 1

Total 0 2 0 2 0 0 5 0 9 1 1 11 4 175.0

≥ 6 Years

Male 0 2 0 0 1 0 0 0 3 1 0 4 2

Female 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 2 0 0 1 0 0 0 3 1 0 4 2 100.0

Total

Male 0 10 0 5 2 1 9 1 28 4 1 33 30

Female 0 1 0 0 1 0 3 1 6 2 0 8 9

Total 0 11 0 5 3 1 12 2 34 6 1 41 39 5.1


106



TABLE SET.17 – Active General Surgery SET Trainees by years in training and training post location



Total 2016

% Change

16/17

1 Year

Male 1 20 3 8 7 3 8 5 55 12 0 67 43

Female 0 9 1 3 2 1 8 2 26 5 0 31 35

Total 1 29 4 11 9 4 16 7 81 17 0 98 78 25.6

2 Years

Male 1 9 1 7 0 1 15 2 36 4 0 40 42

Female 1 15 0 1 1 1 9 1 29 7 0 36 17

Total 2 24 1 8 1 2 24 3 65 11 0 76 59 28.8

3 Years

Male 1 10 1 7 1 2 7 6 35 7 0 42 72

Female 0 6 1 2 0 0 2 0 11 3 0 14 37

Total 1 16 2 9 1 2 9 6 46 10 0 56 109 -48.6

4 Years

Male 0 21 0 11 4 0 17 7 60 9 0 69 49

Female 0 9 0 10 3 0 12 2 36 2 0 38 29

Total 0 30 0 21 7 0 29 9 96 11 0 107 78 37.2

5 Years

Male 0 17 0 10 1 0 10 3 41 5 0 46 58

Female 2 10 0 3 2 0 6 0 23 2 0 25 26

Total 2 27 0 13 3 0 16 3 64 7 0 71 84 -15.5

≥ 6 Years

Male 0 8 0 1 1 0 3 2 15 0 0 15 14

Female 0 4 0 3 1 0 3 0 11 0 0 11 11

Total 0 12 0 4 2 0 6 2 26 0 0 26 25 4.0

Total

Male 3 85 5 44 14 6 60 25 242 37 0 279 278

Female 3 53 2 22 9 2 40 5 136 19 0 155 155

Total 6 138 7 66 23 8 100 30 378 56 0 434 433 0.2

TABLE SET.18 – Active Neurosurgery SET Trainees by years in training and training post location



Total 2016

% Change

16/17

1 Year

Male 1 5 0 1 0 0 1 1 9 1 0 10 10

Female 0 0 0 0 0 0 0 0 0 0 0 0 1

Total 1 5 0 1 0 0 1 1 9 1 0 10 11 -9.1

2 Years

Male 1 2 0 0 1 0 3 1 8 2 0 10 5

Female 0 0 0 0 0 0 0 0 0 1 0 1 3

Total 1 2 0 0 1 0 3 1 8 3 0 11 8 37.5

3 Years

Male 0 1 0 1 0 0 2 0 4 1 0 5 4

Female 0 1 0 1 0 0 1 0 3 0 0 3 2

Total 0 2 0 2 0 0 3 0 7 1 0 8 6 33.3

4 Years

Male 0 1 0 2 1 0 2 0 6 0 0 6 2

Female 0 1 0 0 0 1 0 0 2 0 0 2 2

Total 0 2 0 2 1 1 2 0 8 0 0 8 4 100.0

5 Years

Male 0 1 0 0 0 0 2 0 3 0 0 3 3

Female 0 1 0 1 0 0 0 0 2 0 0 2 4

Total 0 2 0 1 0 0 2 0 5 0 0 5 7 -28.6

≥ 6 Years

Male 0 2 0 0 0 0 0 0 2 0 0 2 9

Female 0 3 0 1 0 0 0 0 4 0 0 4 1

Total 0 5 0 1 0 0 0 0 6 0 0 6 10 -40.0

Total

Male 2 12 0 4 2 0 10 2 32 4 0 36 33

Female 0 6 0 3 0 1 1 0 11 1 0 12 13

Total 2 18 0 7 2 1 11 2 43 5 0 48 46 4.3


107



TABLE SET.19 – Active Orthopaedic SET Trainees by years in training and training post locationa



Total 2016

% Change

16/17

1 Year

Male 1 13 0 12 3 0 12 4 45 10 0 55 48

Female 0 1 0 0 1 0 0 1 3 0 0 3 11

Total 1 14 0 12 4 0 12 5 48 10 0 58 59 -1.7

2 Years

Male 0 14 0 8 4 0 8 6 40 7 0 47 60

Female 0 1 0 1 1 1 5 0 9 3 0 12 7

Total 0 15 0 9 5 1 13 6 49 10 0 59 67 -11.9

3 Years

Male 0 23 0 7 3 1 11 6 51 7 0 58 37

Female 0 3 0 0 1 1 2 0 7 0 0 7 6

Total 0 26 0 7 4 2 13 6 58 7 0 65 43 51.2

4 Years

Male 2 8 0 5 3 1 9 2 30 9 0 39 47

Female 0 0 0 2 0 0 1 0 3 1 0 4 4

Total 2 8 0 7 3 1 10 2 33 10 0 43 51 -15.7

5 Years

Male 2 15 1 8 2 2 6 5 41 8 0 49 50

Female 1 0 0 0 1 0 1 0 3 2 0 5 7

Total 3 15 1 8 3 2 7 5 44 10 0 54 57 -5.3

≥ 6 Years

Male 0 1 0 0 0 0 0 0 1 1 0 2 3

Female 0 0 0 1 0 0 1 0 2 0 0 2 0

Total 0 1 0 1 0 0 1 0 3 1 0 4 3 33.3

Total

Male 5 74 1 40 15 4 46 23 208 42 0 250 245

Female 1 5 0 4 4 2 10 1 27 6 0 33 35

Total 6 79 1 44 19 6 56 24 235 48 0 283 280 1.1


TABLE SET.20 – Active Otolaryngology SET Trainees by years in training and training post location



Total 2016

% Change

16/17

1 Year

Male 1 5 0 3 2 0 0 1 12 3 0 15 8

Female 1 0 0 2 0 0 0 0 3 0 0 3 3

Total 2 5 0 5 2 0 0 1 15 3 0 18 11 63.6

2 Years

Male 0 1 0 0 1 0 3 1 6 2 0 8 9

Female 1 0 1 0 1 0 0 0 3 0 0 3 7

Total 1 1 1 0 2 0 3 1 9 2 0 11 16 -31.3

3 Years

Male 0 2 0 1 1 0 1 0 5 3 0 8 14

Female 0 3 0 1 0 0 0 2 6 1 0 7 8

Total 0 5 0 2 1 0 1 2 11 4 0 15 22 -31.8

4 Years

Male 0 7 0 3 0 0 2 1 13 1 0 14 11

Female 0 1 0 2 0 0 2 1 6 0 0 6 4

Total 0 8 0 5 0 0 4 2 19 1 0 20 15 33.3

5 Years

Male 0 2 0 3 0 0 5 0 10 1 0 11 11

Female 0 0 0 0 0 0 2 1 3 1 0 4 8

Total 0 2 0 3 0 0 7 1 13 2 0 15 19 -21.1

≥ 6 Years

Male 0 0 0 0 0 0 0 0 0 2 0 2 2

Female 0 1 0 1 2 0 1 0 5 0 0 5 3

Total 0 1 0 1 2 0 1 0 5 2 0 7 5 40.0

Total

Male 1 17 0 10 4 0 11 3 46 12 0 58 55

Female 2 5 1 6 3 0 5 4 26 2 0 28 33

Total 3 22 1 16 7 0 16 7 72 14 0 86 88 -2.3


108



TABLE SET.21 – Active Paediatric SET Trainees by years in training and training post location



Total 2016

% Change

16/17

1 Year

Male 0 0 0 1 1 1 0 0 3 2 0 5 2

Female 0 0 0 2 0 0 0 0 2 1 0 3 4

Total 0 0 0 3 1 1 0 0 5 3 0 8 6 33.3

2 Years

Male 0 1 1 0 0 0 0 0 2 0 0 2 4

Female 0 2 0 0 0 0 1 0 3 2 0 5 2

Total 0 3 1 0 0 0 1 0 5 2 0 7 6 16.7

3 Years

Male 0 0 0 0 1 0 0 0 1 2 0 3 1

Female 0 0 0 1 0 0 0 1 2 0 0 2 2

Total 0 0 0 1 1 0 0 1 3 2 0 5 3 66.7

4 Years

Male 0 0 0 0 0 0 1 0 1 0 0 1 4

Female 0 0 0 0 0 0 1 0 1 0 0 1 2

Total 0 0 0 0 0 0 2 0 2 0 0 2 6 -66.7

5 Years

Male 0 0 0 0 0 0 2 0 2 1 0 3 0

Female 0 0 0 1 0 0 0 0 1 0 0 1 4

Total 0 0 0 1 0 0 2 0 3 1 0 4 4 0.0

≥ 6 Years

Male 0 0 0 0 0 0 0 0 0 0 0 0 2

Female 0 4 0 0 0 0 1 0 5 0 0 5 4

Total 0 4 0 0 0 0 1 0 5 0 0 5 6 -16.7

Total

Male 0 1 1 1 2 1 3 0 9 5 0 14 13

Female 0 6 0 4 0 0 3 1 14 3 0 17 18

Total 0 7 1 5 2 1 6 1 23 8 0 31 31 0.0

TABLE SET.22 – Active Plastic and Reconstructive SET Trainees by years in training and training post location



Total 2016

% Change

16/17

1 Year

Male 0 3 0 1 2 0 4 1 11 4 0 15 15

Female 0 1 0 2 0 0 1 3 7 0 0 7 7

Total 0 4 0 3 2 0 5 4 18 4 0 22 22 0.0

2 Years

Male 0 5 0 2 3 0 3 1 14 1 0 15 11

Female 0 0 0 1 0 1 2 0 4 2 0 6 4

Total 0 5 0 3 3 1 5 1 18 3 0 21 15 40.0

3 Years

Male 0 1 0 0 0 0 5 2 8 2 0 10 8

Female 0 1 0 1 0 0 0 0 2 1 0 3 6

Total 0 2 0 1 0 0 5 2 10 3 0 13 14 -7.1

4 Years

Male 0 3 0 1 0 0 2 1 7 1 0 8 14

Female 0 3 0 2 0 0 0 0 5 0 0 5 5

Total 0 6 0 3 0 0 2 1 12 1 0 13 19 -31.6

5 Years

Male 0 5 0 1 2 0 4 5 17 1 0 18 16

Female 0 2 0 0 1 0 2 0 5 1 0 6 9

Total 0 7 0 1 3 0 6 5 22 2 0 24 25 -4.0

≥ 6 Years

Male 0 2 0 0 0 0 1 0 3 0 0 3 1

Female 0 0 0 0 1 0 1 1 3 0 0 3 0

Total 0 2 0 0 1 0 2 1 6 0 0 6 1 500.0

Total

Male 0 19 0 5 7 0 19 10 60 9 0 69 65

Female 0 7 0 6 2 1 6 4 26 4 0 30 31

Total 0 26 0 11 9 1 25 14 86 13 0 99 96 3.1


109



TABLE SET.23 – Active Urology SET Trainees by years in training and training post location



Total 2016

% Change

16/17

1 Year

Male 0 5 0 2 1 0 3 1 12 3 0 15 20

Female 0 1 0 2 0 0 1 0 4 1 0 5 3

Total 0 6 0 4 1 0 4 1 16 4 0 20 23 -13.0

2 Years

Male 0 7 0 4 1 1 1 1 15 4 0 19 1

Female 0 1 0 0 0 0 0 1 2 0 0 2 2

Total 0 8 0 4 1 1 1 2 17 4 0 21 3 600.0

3 Years

Male 0 0 0 1 0 0 0 0 1 0 0 1 11

Female 0 0 0 0 0 0 2 0 2 0 0 2 4

Total 0 0 0 1 0 0 2 0 3 0 0 3 15 -80.0

4 Years

Male 0 2 0 2 1 0 3 1 9 2 0 11 15

Female 0 1 0 0 0 0 1 1 3 1 0 4 5

Total 0 3 0 2 1 0 4 2 12 3 0 15 20 -25.0

5 Years

Male 0 5 0 4 1 0 5 0 15 0 0 15 20

Female 0 2 0 1 1 0 0 1 5 0 0 5 7

Total 0 7 0 5 2 0 5 1 20 0 0 20 27 -25.9

≥ 6 Years

Male 0 5 0 4 0 0 7 0 16 0 0 16 13

Female 0 2 0 2 0 0 1 0 5 2 0 7 3

Total 0 7 0 6 0 0 8 0 21 2 0 23 16 43.8

Total

Male 0 24 0 17 4 1 19 3 68 9 0 77 80

Female 0 7 0 5 1 0 5 3 21 4 0 25 24

Total 0 31 0 22 5 1 24 6 89 13 0 102 104 -1.9

TABLE SET.24 – Active Vascular Surgery SET Trainees by years in training and training post location



Total 2016

% Change

16/17

1 Year

Male 0 4 0 1 0 0 2 0 7 0 0 7 7

Female 0 0 0 0 0 0 0 1 1 1 0 2 1

Total 0 4 0 1 0 0 2 1 8 1 0 9 8 12.5

2 Years

Male 0 1 0 0 1 0 3 0 5 2 0 7 4

Female 0 1 0 1 0 0 0 0 2 1 0 3 4

Total 0 2 0 1 1 0 3 0 7 3 0 10 8 25.0

3 Years

Male 0 2 0 0 0 0 0 0 2 2 0 4 12

Female 0 1 0 0 1 0 1 0 3 0 0 3 1

Total 0 3 0 0 1 0 1 0 5 2 0 7 13 -46.2

4 Years

Male 0 5 0 0 1 0 3 1 10 2 0 12 10

Female 0 0 0 0 0 0 1 0 1 0 0 1 1

Total 0 5 0 0 1 0 4 1 11 2 0 13 11 18.2

5 Years

Male 0 2 0 1 1 0 0 0 4 0 0 4 3

Female 0 0 0 1 0 0 0 0 1 0 0 1 0

Total 0 2 0 2 1 0 0 0 5 0 0 5 3 66.7

≥ 6 Years

Male 0 0 0 0 0 0 1 0 1 1 0 2 2

Female 0 1 0 0 0 0 0 0 1 0 0 1 1

Total 0 1 0 0 0 0 1 0 2 1 0 3 3 0.0

Total

Male 0 14 0 2 3 0 9 1 29 7 0 36 38

Female 0 3 0 2 1 0 2 1 9 2 0 11 8

Total 0 17 0 4 4 0 11 2 38 9 0 47 46 2.2


110

SECTION FOUR ACTIVITIES OF EXAMINATIONS


EXPLANATORY NOTESLocation – State and/or Country reflected in these reports refer to the candidate’s mailing address. This is not necessarily the location where the candidate has undertaken all of their training, oversight and/or or examinations.

Surgical Science Examinations – Generic and Speciality SpecificThe Generic Surgical Science Examination (GSSE) comprises two components and is mandatory for all specialities. Numbers reflected in these reports are representative of all examination sittings held in Australia and New Zealand in 2017 (including all attempts). As passing the GSSE is now a requirement prior to applying to the SET program for all specialties, the number of new SET Trainees that have already passed the GSSE prior to commencing SET training is increasing. Conversely, the number of existing SET Trainees who will sit for the GSSE will decrease. The name change to Table EXAM.1 to include the term ‘SET Trainees’ highlights this change. The GSSE was conducted three times in 2017 for prevocational doctors and twice for SET Trainees.

All specialty specific examinations are presented in the one table and indicate all sittings and all attempts (Table EXAM.2). Held concurrently with the GSSE, the Specialty Specific Examination is conducted for Otolaryngology Head and Neck Surgery, Urology and Vascular Surgery. For Trainees commencing from 2014, the Board in General Surgery replaced the Specialty Specific Examination in General Surgery with Surgical Education and Assessment Modules (SEAM); SEAM is not reported by RACS. For Trainees commencing from 2016, the Board of Neurosurgery removed the specialty specific examination as a training requirement. The remaining speciality specific examinations are the Cardiothoracic Surgical Science and Principles (CSSP), Orthopaedic Principles and Basic Sciences (OPBS), Plastic and Reconstructive Surgical Sciences and Principles (PRSSP) and the Paediatric Anatomy and Embryology (PAE) and Paediatric Pathology and Pathophysiology (PPE) Examinations.

Clinical ExaminationTThe Clinical Examination consists of 16 Objective Structured Clinical Examinations (OSCE) stations. Numbers reflected in the Clinical Examination report are representative of the exams held in Australia and New Zealand for all sittings and all attempts. For Trainees commencing from 2016, the Board of Neurosurgery removed the Clinical Examination as a requirement.

Fellowship Examinations (FEX)Numbers reflected in the Fellowship Examination reports are representative of the exams held in Australia and New Zealand in May and September 2017 and reported with respect to:

• Individual sitting and annual pass rate

• Eventual pass rate by specialty (compares the number of candidates successfully completing the Fellowship Examinations within a 5 year period since first attempt; includes SET Trainees and IMGs

• Annual Fellowship Examination pass rate by state and specialty – SET Trainees

• Annual Fellowship Examination pass rate by state and specialty – International Medical Graduates

• Cumulative attempts to pass the Fellowship Examination (all candidates presenting in 2017 and the number of attempts). Note that previous reporting of this table has always included cumulative attempts for both SET and IMGs, and we have changed the title of this table to reflect this.

Data reporting in Tables EXAM.6 and EXAM.7Tables EXAM.6 and EXAM.7 report annual pass rates. The annual pass rate reports on the overall success of the candidate passing Fellowship Exam within the calendar year. Previous years Activities Reports have reported the individual pass rate attempts.

Table EXAM.8 reports the number of female and male candidates who present for the Fellowship Examinations. The numbers represented include SET Trainees and IMGs who sat and passed the FEX within the calendar year by specialty. Activities Reports from earlier years did not report this information.


111

SECTION 4: ACTIVITIES OF EXAMINATIONS


DATA SUMMARYGeneric and Specialty Specific Surgical Science ExaminationsThe number of SET Trainees sitting the GSSE has decreased sharply from 2016, reflecting the policy change that requires prevocational doctors to pass the exam prior to applying to the SET program. The cumulative pass rate for the prevocational doctor cohort decreased from 70.9% in 2016 to 61.2% in 2017 (Table EXAM.10).

The 84.8% pass rate in the Specialty Specific Surgical Science Examination this year was an increase from the 75.3% pass rate in 2016.

Clinical Examination The pass rate for the Clinical Examination was 79.3%, a decrease of 4.4%. Neurosurgery SET Trainees are not required to present for the Clinical Examination.

Fellowship ExaminationThe overall pass rate for the Fellowship Examination has decreased by 7.3% in 2017 compared to 2016 (Table EXAM.4). There was also a decrease in the total numbers both SET Trainees and IMGs sitting for the exam compared to 2016. The overall pass rate for SET Trainees continues to vary between specialties (Table EXAM.6).

The eventual Fellowship Examination pass rate for SET Trainees and IMGs continues to be consistent across the last four Trainee cohorts, with the last two cohorts reporting an eventual pass rate of more than 98% (Table EXAM.5). The eventual pass rate of the IMG cohort remains at a comparable level compared to the SET cohort.

The number of female candidates sitting for the Fellowship Examination increased from 77 candidates in 2016 to 93 candidates in 2017. By gender, the pass rate for female candidates increased by 2% but decreased for male candidates by 8% (Table EXAM.8).

Compared to 2016, the annual pass rate has decreased for first attempt and second attempts. The numbers take into consideration both SET Trainees and IMGs. The pass rate for General surgery at the first attempt decreased from 73% in 2016 to 67% in 2017, while for Orthopaedic Surgery the pass rate increased from 78% in 2016 to 88% in 2017 (Table EXAM.9).

RACS continues to monitor examination pass rates and identify areas for ongoing improvement.


112



TABLE EXAM.1 – SET Trainee pass rate of individual attempts (total sittings) at Generic Surgical Science Examination by specialty and location


Total NZ O/STotal 2017 % Pass

CARSat 0 1 0 0 0 0 0 0 1 0 0 1

100.0Pass 0 1 0 0 0 0 0 0 1 0 0 1

GENSat 2 1 0 2 0 0 4 0 9 0 0 9

77.8Pass 1 0 0 2 0 0 4 0 7 0 0 7

NEUSat 0 0 0 0 0 0 0 0 0 0 0 0

–Pass 0 0 0 0 0 0 0 0 0 0 0 0

ORTSat 0 0 0 0 0 0 4 0 4 2 0 6

16.7Pass 0 0 0 0 0 0 1 0 1 0 0 1

OTOSat 0 3 0 1 0 0 0 0 4 3 0 7

71.4Pass 0 1 0 1 0 0 0 0 2 3 0 5

PAESat 0 0 0 0 0 0 0 0 0 0 0 0

–Pass 0 0 0 0 0 0 0 0 0 0 0 0

PLASat 0 0 0 1 0 0 0 4 5 2 0 7

14.3Pass 0 0 0 0 0 0 0 0 0 1 0 1

UROSat 0 0 0 0 0 0 0 0 0 0 0 0

–Pass 0 0 0 0 0 0 0 0 0 0 0 0

VASSat 0 0 0 0 0 0 1 0 1 0 0 1

100.0Pass 0 0 0 0 0 0 1 0 1 0 0 1

Total

Sat 2 5 0 4 0 0 9 4 24 7 0 31

51.6Pass 1 2 0 3 0 0 6 0 12 4 0 16

% Pass 50.0 40.0 – 75.0 – – 66.7 0.0 50.0 57.1 – 51.6

Note: Sat numbers are based on unique candidates; that is, candidates who sat multiple times for examinations are only counted once.

FIGURE EXAM.1 – Overall annual pass rate of individual attempts (total sittings) at Generic Surgical Science Examination (2010-2017)

100

90

80

70

60

50

40

30

20

10

0

2011 2012 2013 2014

Pass Rate (%)

Year

2015 2016 2017


113



TABLE EXAM.2 – Pass rate of individual attempts (total sittings) at Specialty Specific Surgical Science Examination by specialty and location



CAR(CSSP)

Sat 0 1 0 1 0 1 4 1 8 1 0 966.7

Pass 0 0 0 1 0 0 3 1 5 1 0 6

GENSat 0 0 0 0 0 0 0 0 0 0 0 0

–Pass 0 0 0 0 0 0 0 0 0 0 0 0

NEU Sat 0 0 0 0 0 0 0 0 0 0 0 0

–Pass 0 0 0 0 0 0 0 0 0 0 0 0

ORT(OPBS)

Sat 1 35 0 16 4 1 20 6 83 11 0 9480.9

Pass 1 26 0 15 4 0 16 3 65 11 0 76

OTOSat 0 8 0 6 2 0 1 0 17 3 0 20

85.0Pass 0 7 0 4 2 0 1 0 14 3 0 17

PAE(PAEE)

Sat 1 0 1 3 2 0 0 0 7 2 0 966.7

Pass 0 0 1 2 2 0 0 0 5 1 0 6

PAE(PPPE)

Sat 0 2 0 1 1 0 0 0 4 2 0 6100.0

Pass 0 2 0 1 1 0 0 0 4 2 0 6

PLA(PRSSP)

Sat 0 3 0 4 3 0 10 0 20 5 0 2592.0

Pass 0 1 0 4 3 0 10 0 18 5 0 23

UROSat 0 4 0 2 1 1 6 1 15 5 0 20

100.0Pass 0 4 0 2 1 1 6 1 15 5 0 20

VASSat 0 3 0 0 1 0 3 0 7 1 0 8

100.0Pass 0 3 0 0 1 0 3 0 7 1 0 8

Total

Sat 2 56 1 33 14 3 44 8 161 30 0 191

84.8Pass 1 43 1 29 14 1 39 5 133 29 0 162

% Pass 50.0 76.8 100.0 87.9 100.0 33.3 88.6 62.5 82.6 96.7 – 84.8

Note: Sat numbers are based on unique candidates; that is, candidates who sat multiple times for examinations are only counted once

FIGURE EXAM.2 – Overall annual pass rate of individual attempts (total sittings) at Specialty Specific Surgical Science Examination (2010-2017)

90

80

70

60

50

40

30

20

10

0

2010 2011 2012 2013

Pass Rate (%)

Year

2014 2015 2016 2017


114



TABLE EXAM.3 – Pass rate of individual attempts (total sittings) at Clinical Examination by specialty and location



CARSat 0 2 0 0 0 0 1 1 4 1 0 5

60.0Pass 0 2 0 0 0 0 0 0 2 1 0 3

GENSat 4 26 1 16 11 2 27 9 96 19 0 115

79.1Pass 2 22 1 15 9 1 20 6 76 15 0 91

NEUSat 0 0 0 0 0 0 0 0 0 0 0 0

–Pass 0 0 0 0 0 0 0 0 0 0 0 0

ORTSat 2 20 0 14 5 0 18 7 66 9 0 75

84.0Pass 1 16 0 13 4 0 16 6 56 7 0 63

OTOSat 0 6 0 4 0 0 2 0 12 4 0 16

62.5Pass 0 5 0 2 0 0 1 0 8 2 0 10

PAESat 0 1 0 0 0 1 0 0 2 5 0 7

42.9Pass 0 0 0 0 0 0 0 0 0 3 0 3

PLASat 0 7 0 4 2 0 5 3 21 6 0 27

85.2Pass 0 6 0 3 1 0 5 2 17 6 0 23

UROSat 1 7 0 3 0 1 4 0 16 5 0 21

85.7Pass 1 4 0 3 0 1 4 0 13 5 0 18

VASSat 0 1 0 1 2 1 3 0 8 1 0 9

77.8Pass 0 0 0 0 2 1 3 0 6 1 0 7

Total

Sat 7 70 1 42 20 5 60 20 225 50 0 275

79.3Pass 4 55 1 36 16 3 49 14 178 40 0 218

% Pass 57.1 78.6 100.0 85.7 80.0 60.0 81.7 70.0 79.1 80.0 – 79.3

FIGURE EXAM. 3 – Overall annual pass rate of individual attempts (total sittings) at Clinical Examination (2010-2017)

100

95

90

85

80

75

70

65

60

55

50

2010 2011 2012 2013

Pass Rate (%)

Year

2014 2015 2016 2017


115



TABLE EXAM.4 – SET and IMG individual attempts and annual pass rate of Fellowship Examinations by specialty

May(Total sittings)

September(Total sittings)

Pass rate (Total sittings)a Annual Pass Rateb

Sat Pass % Sat Pass % Sat Pass % Sat Pass %

CAR 6 3 50.0 5 2 40.0 11 5 45.5 8 5 62.5

GEN 79 53 67.1 39 23 59.0 118 76 64.4 95 76 80.0

NEU 4 4 100.0 3 3 100.0 7 7 100.0 7 7 100.0

ORT 62 47 75.8 22 10 45.5 84 57 67.9 70 57 81.4

OTO 18 11 61.1 7 3 42.9 25 14 56.0 21 14 66.7

PAE 2 1 50.0 2 0 0.0 4 1 25.0 3 1 33.3

PLA 22 14 63.6 12 6 50.0 34 20 58.8 26 20 76.9

URO 14 12 85.7 17 8 47.1 31 20 64.5 29 20 69.0

VAS 7 5 71.4 6 2 33.3 13 7 53.8 12 7 58.3

Total 214 150 70.1 113 57 50.4 327 207 63.3 271 207 76.4

a Total sittings: records numbers of candidates; some candidates sit twice during a year. b Annual pass rate reports on the success rate of the individual candidates (over 1 or 2 sittings) passing Fellowship Exam in 2017.

TABLE EXAM.5 – Eventual Fellowship Examination pass rate by specialty This table compares the number of Trainees successfully completing the Fellowship Examination within a 5 year period since first attempt (including IMGs).

2009 2014

% Fellows 09/14

2010 2015

% Fellows 10/15

2011 2016

% Fellows 11/16

2012 2017

% Fellows 12/17

Initially Sat

Eventual Pass

Initially Sat

Eventual Pass

Initially Sat

Eventual Pass

Initially Sat

Eventual Pass

CARTrainee 2 2 100.0 15 14 93.3 2 2 100.0 7 7 100.0

IMG 2 2 100.0 2 2 100.0 0 0 – 2 2 100.0

GENTrainee 65 62 95.4 60 58 96.7 85 85 100.0 85 83 97.6

IMG 16 16 100.0 8 6 75.0 7 5 71.4 7 6 85.7

NEUTrainee 8 8 100.0 9 8 88.9 4 4 100.0 10 10 100.0

IMG 3 3 100.0 2 2 100.0 3 3 100.0 1 1 100.0

ORTTrainee 57 57 100.0 61 61 100.0 56 55 98.2 56 54 96.4

IMG 6 5 83.3 8 7 87.5 5 5 100.0 6 6 100.0

OTOTrainee 18 17 94.4 23 22 95.7 16 16 100.0 20 20 100.0

IMG 3 3 100.0 4 3 75.0 1 1 100.0 2 1 50.0

PAETrainee 3 3 100.0 4 4 100.0 4 4 100.0 3 3 100.0

IMG 1 1 100.0 1 1 100.0 2 1 50.0 0 0 –

PLATrainee 15 15 100.0 21 19 90.5 26 26 100.0 13 13 100.0

IMG 2 1 50.0 1 1 100.0 1 1 100.0 3 2 66.7

UROTrainee 19 19 100.0 20 19 95.0 19 19 100.0 22 22 100.0

IMG 0 0 0.0 6 6 100.0 2 2 100.0 2 2 100.0

VASTrainee 11 11 100.0 9 9 100.0 8 8 100.0 7 7 100.0

IMG 1 1 100.0 1 1 100.0 0 0 – 0 0 –

TotalTrainee 198 194 98.0 222 214 96.4 220 219 99.5 223 219 98.2

IMG 34 32 94.1 33 29 87.9 21 18 85.7 23 20 87.0


116



TABLE EXAM.6 – Fellowship Examinations pass rate (per sitting) of SET Trainees by location and specialty



CARSat 0 5 0 1 0 0 2 0 8 1 0 9

44.4Pass 0 2 0 1 0 0 0 0 3 1 0 4

GENSat 0 41 0 21 6 0 23 6 97 12 0 109

67.9Pass 0 25 0 14 3 0 18 5 65 9 0 74

NEUSat 1 4 0 1 0 0 0 0 6 0 0 6

100.0Pass 1 4 0 1 0 0 0 0 6 0 0 6

ORTSat 3 13 0 9 5 0 13 6 49 15 0 64

79.7Pass 1 12 0 9 3 0 11 5 41 10 0 51

OTOSat 1 2 0 5 0 0 7 1 16 7 0 23

60.9Pass 1 1 0 4 0 0 5 1 12 2 0 14

PAESat 0 3 0 0 0 0 1 0 4 0 0 4

25.0Pass 0 0 0 0 0 0 1 0 1 0 0 1

PLA Sat 0 12 0 1 4 0 7 3 27 3 1 3164.5

Pass 0 6 0 1 3 0 5 1 16 3 1 20

UROSat 0 10 0 4 1 0 8 1 24 2 0 26

65.4Pass 0 7 0 2 1 0 5 1 16 1 0 17

VASSat 1 3 0 1 1 0 1 0 7 3 0 10

50.0Pass 0 1 0 1 1 0 1 0 4 1 0 5

Total

Sat 6 93 0 43 17 0 62 17 238 43 1 282

Pass 3 58 0 33 11 0 46 13 164 27 1 192 68.1

% Pass 50.0 62.4 – 76.7 64.7 – 74.2 76.5 68.9 62.8 – 68.1

TABLE EXAM.7 – Fellowship Examinations pass rate (per sitting) of International Medical Graduates by location and specialty



CAR Sat 0 0 0 2 0 0 0 0 2 0 0 2

50.0Pass 0 0 0 1 0 0 0 0 1 0 0 1

GENSat 0 2 2 2 1 0 1 1 9 0 0 9

–Pass 0 0 0 1 0 0 1 0 2 0 0 2

NEU Sat 0 1 0 0 0 0 0 0 1 0 0 1

–Pass 0 1 0 0 0 0 0 0 1 0 0 1

ORTSat 0 4 0 6 1 0 6 3 20 0 0 20

30.0Pass 0 0 0 2 0 0 3 1 6 0 0 6

OTOSat 0 0 0 0 0 0 2 0 2 0 0 2

0.0Pass 0 0 0 0 0 0 0 0 0 0 0 0

PAESat 0 0 0 0 0 0 0 0 0 0 0 0

–Pass 0 0 0 0 0 0 0 0 0 0 0 0

PLASat 0 2 0 0 0 0 0 1 3 0 0 3

0.0Pass 0 0 0 0 0 0 0 0 0 0 0 0

UROSat 0 0 0 1 0 1 3 0 5 0 0 5

60.0Pass 0 0 0 1 0 1 1 0 3 0 0 3

VASSat 0 0 0 2 0 0 0 1 3 0 0 3

66.7Pass 0 0 0 1 0 0 0 1 2 0 0 2

Total

Sat 0 9 2 13 2 1 12 6 45 0 0 45

Pass 0 1 0 6 0 1 5 2 15 0 0 15 33.3

% Pass – 11.1 0.0 46.2 0.0 100.0 41.7 33.3 33.3 – – 33.3


117



TABLE EXAM.8 – Fellowship Examinations pass rate (per sitting) of SET and IMG by gender and specialty


%Pass

Female Sat 0 45 4 6 11 4 13 8 2 93

65.6Pass 0 29 4 6 6 1 9 6 0 61

MaleSat 11 73 3 78 14 0 21 23 11 234

62.4Pass 5 47 3 51 8 0 11 14 7 146

Total

Sat 11 118 7 84 25 4 34 31 13 327 63.3

Pass 5 76 7 57 14 1 20 20 7 207

% Pass 45.5 64.4 100.0 67.9 56.0 25.0 58.8 64.5 53.8 63.3 65.6

TABLE EXAM.9 – SET Trainees and IMGs cumulative attempts to pass Fellowship Examination by specialty for candidates presenting in 2017

Attempt Number CAR GEN NEU ORT OTO PAE PLA URO VAS

Total 2017

Total 2016

1

Sat 7 85 4 57 16 3 20 23 11 226 253

Pass 3 57 4 50 10 1 13 13 7 158 189

% pass 43 67 100 88 63 33 65 57 64 70 75

2

Sat 4 28 1 7 4 1 8 5 1 59 70

Pass 2 18 1 3 2 0 4 4 0 34 49

% pass 50 64 100 43 50 0 50 80 0 58 70

3

Sat 0 2 1 7 2 0 4 2 1 19 28

Pass 0 1 1 0 1 0 2 2 0 7 15

% pass – 50 100 0 50 – 50 100 0 37 54

4

Sat 0 1 0 8 1 0 1 1 0 12 15

Pass 0 0 0 2 1 0 0 1 0 4 8

% pass – 0 – 25 100 – 0 100 – 33 53

5

Sat 0 1 0 4 0 0 1 0 0 6 7

Pass 0 0 0 1 0 0 1 0 0 2 0

% pass – 0 – 25 – – 100 – – 33 0

6

Sat 0 1 1 0 1 0 0 0 0 3 2

Pass 0 0 1 0 0 0 0 0 0 1 0

% pass – 0 100 – 0 – – – – 33 0

7

Sat 0 0 0 1 0 0 0 0 0 1 1

Pass 0 0 0 1 0 0 0 0 0 1 0

% pass – – – 100 – – – – – 100 0

8

Sat 0 0 0 0 1 0 0 0 0 1 1

Pass 0 0 0 0 0 0 0 0 0 0 0

% pass – – – – 0 – – – – 0 0

Total

Sat 11 118 7 84 25 4 34 31 13 327 378

Pass 5 76 7 57 14 1 20 20 7 207 261

% pass 45.5 64.4 100.0 67.9 56.0 25.0 58.8 64.5 53.8 63.3 69.0


118



FIGURE EXAM.4 –Overall Fellowship Examination pass rate of SET Trainees and IMGs (2010-2017)

TABLE EXAM.10 – Non-SET cumulative attempts to pass Generic Surgical Science Examination by location

Attempt Number ACT NSW NT QLD SA TAS VIC WA

AUSTOTAL NZ O/S

Total 2017

1

Sat 12 198 2 126 38 7 145 65 593 103 3 699

Pass 11 142 2 94 23 4 96 37 409 89 2 500

% pass 91.7 71.7 100.0 74.6 60.5 57.1 66.2 56.9 69.0 86.4 0.0 71.5

2

Sat 2 53 2 34 8 2 45 27 173 12 0 185

Pass 1 23 1 19 3 1 17 11 76 6 0 82

% pass 50.0 43.4 50.0 55.9 37.5 50.0 37.8 40.7 43.9 50.0 – 44.3

3

Sat 2 31 1 13 6 0 17 8 78 9 1 88

Pass 0 11 0 9 4 0 6 3 33 2 0 35

% pass 0.0 35.5 0.0 69.2 66.7 – 35.3 37.5 42.3 22.2 0.0 39.8

4

Sat 2 16 1 9 1 0 11 1 41 5 0 46

Pass 0 1 1 1 1 0 4 0 8 2 0 10

% pass 0.0 6.3 100.0 11.1 100.0 0.0 36.4 0.0 19.5 40.0 – 21.7

5

Sat 0 5 0 5 0 0 2 1 13 0 0 13

Pass 0 0 0 4 0 0 1 1 6 0 0 6

% pass – 0.0 – 80.0 – – 50.0 100.0 46.2 – – 46.2

6

Sat 1 3 0 1 0 0 1 0 6 0 0 6

Pass 1 2 0 0 0 0 0 0 3 0 0 3

% pass 100.0 66.7 – 0.0 – – 0.0 – 50.0 – – 50.0

7

Sat 0 1 0 2 0 0 0 0 3 0 0 3

Pass 0 0 0 1 0 0 0 0 1 0 0 1

% pass – 0.0 – 50.0 – – – – 33.3 – – 33.3

8

Sat 0 0 0 1 0 0 0 0 1 0 0 1

Pass 0 0 0 0 0 0 0 0 0 0 0 0

% pass – – – 0.0 – – – – 0.0 – – 0

Total

Sat 19 307 6 191 53 9 221 102 908 129 4 1041

Pass 13 179 4 128 31 5 124 52 536 99 2 637

% pass 68.4 58.3 66.7 67.0 58.5 55.6 59.3 51.0 59.0 76.7 50.0 61.2

75

70

65

60

55

50

2010 2011 2012 2013

Pass Rate (%)

Year

2014 2015 2016 2017


119


EXPLANATORY NOTESIn all tables the last known address is used when the current address is unknown. Region is based on mailing postcode and country. An active Fellow is involved in medicine, surgery, medico-legal work or other specialist non-procedural and non-clinical work such as surgical administration and academia.

DATA SUMMARY In 2017, there were 7429 Fellows across Australia, New Zealand and overseas (Table WFD.1). Of these 5179 were active Fellows in Australia and 820 were active Fellows in New Zealand.

The number of admissions to RACS Fellowship was slightly lower in 2017 compared to the previous year, with 241 SET Trainees and International Medical Graduates obtaining Fellowship (Table WFD.11). Almost 22% of surgeons who achieved Fellowship through the SET pathway were female (Table WFD.9), while almost 21% of IMGs who obtained Fellowship were female (Table WFD.10). Female surgeons make up 12% of the active surgical workforce, with the number of female surgeons in active practice increasing by 7% in the last year (Table WFD.3).

The proportion of surgeons located in rural or regional areas remains steady. The specialties of General surgery (20%), Orthopaedic surgery (16%), and Urology (16%) have the largest proportion of Fellows working in rural and remote areas of Australia (Table WFD.6).

SECTION FIVE WORKFORCE DISTRIBUTION


120



TABLE WFD.1 – Active and retired RACS Fellows by location and specialty



Total 2016

% Change

16/17

CAR

Male 6 65 0 42 15 4 60 18 210 34 32 276 276 0.0

Female 0 5 0 2 0 0 7 1 15 3 0 18 17 5.9

Total 6 70 0 44 15 4 67 19 225 37 32 294 293 0.3

GEN

Male 24 637 18 344 162 31 489 157 1862 279 172 2313 2273 1.8

Female 4 96 3 51 26 6 87 24 297 43 21 361 335 7.8

Total 28 733 21 395 188 37 576 181 2159 322 193 2674 2608 2.5

NEU

Male 7 79 0 47 18 8 62 21 242 23 32 297 289 2.8

Female 1 8 0 8 5 1 8 1 32 1 1 34 33 3.0

Total 8 87 0 55 23 9 70 22 274 24 33 331 322 2.8

ORT

Male 21 459 4 306 127 22 320 142 1401 278 65 1744 1714 1.8

Female 3 16 0 11 5 0 17 3 55 16 2 73 66 10.6

Total 24 475 4 317 132 22 337 145 1456 294 67 1817 1780 2.1

OTO

Male 12 154 2 97 46 6 113 45 475 84 28 587 579 1.4

Female 1 24 0 10 5 2 22 3 67 18 4 89 82 8.5

Total 13 178 2 107 51 8 135 48 542 102 32 676 661 2.3

PAE

Male 3 32 0 15 5 2 27 7 91 16 28 135 134 0.7

Female 1 10 0 4 3 1 8 4 31 3 7 41 40 2.5

Total 4 42 0 19 8 3 35 11 122 19 35 176 174 1.1

PLA

Male 4 128 2 62 44 11 134 49 434 60 18 512 503 1.8

Female 0 15 0 14 8 1 26 6 70 13 8 91 83 9.6

Total 4 143 2 76 52 12 160 55 504 73 26 603 586 2.9

URO

Male 7 143 1 96 34 12 121 39 453 66 28 547 531 3.0

Female 0 12 0 7 3 0 17 7 46 7 2 55 52 5.8

Total 7 155 1 103 37 12 138 46 499 73 30 602 583 3.3

VAS

Male 4 66 0 38 19 5 59 18 209 19 4 232 223 4.0

Female 0 8 0 6 2 0 6 1 23 1 0 24 24 0.0

Total 4 74 0 44 21 5 65 19 232 20 4 256 247 3.6

Sub Total

Male 88 1763 27 1047 470 101 1385 496 5377 859 407 6643 6522 1.9

Female 10 194 3 113 57 11 198 50 636 105 45 786 732 7.4

Total 98 1957 30 1160 527 112 1583 546 6013 964 452 7429 7254 2.4

OB & GYN

Male 0 6 0 1 0 0 14 0 21 0 1 22 23 -4.3

Female 0 0 0 0 0 0 0 0 0 0 0 0 0 –

Total 0 6 0 1 0 0 14 0 21 0 1 22 23 -4.3

OPH

Male 4 82 0 47 13 5 64 18 233 12 8 253 266 -4.9

Female 0 14 1 2 2 0 13 1 33 2 0 35 36 -2.8

Total 4 96 1 49 15 5 77 19 266 14 8 288 302 -4.6

Total

Male 92 1851 27 1095 483 106 1463 514 5631 871 416 6918 6811 1.6

Female 10 208 4 115 59 11 211 51 669 107 45 821 768 6.9

Total 102 2059 31 1210 542 117 1674 565 6300 978 461 7739 7579 2.1


121

SECTION 5: WORKFORCE DISTRIBUTION


TABLE WFD.2 – Active RACS Fellows by location and specialty



Total 2016

% Change

16/17

CAR

Male 5 54 0 37 11 3 52 14 176 28 22 226 224 0.9

Female 0 5 0 2 0 0 6 1 14 3 0 17 16 6.3

Total 5 59 0 39 11 3 58 15 190 31 22 243 240 1.3

GEN

Male 20 492 17 266 122 22 388 120 1447 208 128 1783 1745 2.2

Female 4 94 3 50 25 6 86 24 292 41 20 353 327 8.0

Total 24 586 20 316 147 28 474 144 1739 249 148 2136 2072 3.1

NEU

Male 7 70 0 43 11 6 61 19 217 20 25 262 257 1.9

Female 1 8 0 8 5 1 8 1 32 1 1 34 33 3.0

Total 8 78 0 51 16 7 69 20 249 21 26 296 290 2.1

ORT

Male 20 424 3 288 114 21 296 127 1293 252 49 1594 1561 2.1

Female 3 16 0 11 5 0 17 3 55 15 2 72 65 10.8

Total 23 440 3 299 119 21 313 130 1348 267 51 1666 1626 2.5

OTO

Male 8 129 2 83 40 6 97 38 403 76 22 501 492 1.8

Female 1 24 0 10 5 2 22 3 67 18 4 89 82 8.5

Total 9 153 2 93 45 8 119 41 470 94 26 590 574 2.8

PAE

Male 2 25 0 11 4 2 16 5 65 13 19 97 96 1.0

Female 1 10 0 3 3 0 7 4 28 3 5 36 36 0.0

Total 3 35 0 14 7 2 23 9 93 16 24 133 132 0.8

PLA

Male 3 113 2 52 37 9 124 40 380 51 16 447 443 0.9

Female 0 14 0 13 7 1 26 6 67 13 8 88 82 7.3

Total 3 127 2 65 44 10 150 46 447 64 24 535 525 1.9

URO

Male 6 123 1 82 28 12 107 33 392 53 22 467 454 2.9

Female 0 12 0 7 3 0 17 7 46 7 2 55 52 5.8

Total 6 135 1 89 31 12 124 40 438 60 24 522 506 3.2

VAS

Male 4 61 0 33 16 4 50 14 182 17 3 202 192 5.2

Female 0 8 0 6 2 0 6 1 23 1 0 24 24 0.0

Total 4 69 0 39 18 4 56 15 205 18 3 226 216 4.6

Sub Total

Male 75 1491 25 895 383 85 1191 410 4555 718 306 5579 5464 2.1

Female 10 191 3 110 55 10 195 50 624 102 42 768 717 7.1

Total 85 1682 28 1005 438 95 1386 460 5179 820 348 6347 6181 2.7

OB & GYN

Male 0 1 0 0 0 0 0 0 1 0 0 1 2 -50.0

Female 0 0 0 0 0 0 0 0 0 0 0 0 0 –

Total 0 1 0 0 0 0 0 0 1 0 0 1 2 -50.0

OPH

Male 2 67 0 32 10 3 53 11 178 6 5 189 201 -6.0

Female 0 13 1 1 2 0 13 1 31 2 0 33 34 -2.9

Total 2 80 1 33 12 3 66 12 209 8 5 222 235 -5.5

Total

Male 77 1559 25 927 393 88 1244 421 4734 724 311 5769 5667 1.8

Female 10 204 4 111 57 10 208 51 655 104 42 801 751 6.7

Total 87 1763 29 1038 450 98 1452 472 5389 828 353 6570 6418 2.4


122



TABLE WFD.3 – Active RACS Fellows by location and age

Age group(years) ACT NSW NT QLD SA TAS VIC WA

AUSTotal NZ O/S

Total 2017

Total 2016

% Change

16/17

<35

Male 2 50 1 20 11 2 51 7 144 32 12 188 190 -1.1

Female 1 19 1 10 2 2 25 1 61 5 6 72 80 -10.0

Total 3 69 2 30 13 4 76 8 205 37 18 260 270 -3.7

35-39

Male 6 114 1 76 33 5 116 35 386 59 27 472 488 -3.3

Female 0 39 0 25 11 0 40 13 128 22 6 156 144 8.3

Total 6 153 1 101 44 5 156 48 514 81 33 628 632 -0.6

40-44

Male 9 243 3 163 58 9 201 73 759 83 40 882 886 -0.5

Female 3 55 1 30 12 1 39 11 152 28 13 193 180 7.2

Total 12 298 4 193 70 10 240 84 911 111 53 1075 1066 0.8

45-49

Male 19 234 5 169 64 16 179 87 773 115 34 922 869 6.1

Female 4 31 1 20 13 4 35 12 120 17 6 143 125 14.4

Total 23 265 6 189 77 20 214 99 893 132 40 1065 994 7.1

50-54

Male 10 206 6 130 49 8 150 50 609 110 29 748 745 0.4

Female 1 22 0 13 7 1 23 8 75 13 2 90 82 9.8

Total 11 228 6 143 56 9 173 58 684 123 31 838 827 1.3

55-59

Male 10 150 2 126 42 13 119 51 513 108 43 664 647 2.6

Female 1 14 0 8 6 0 20 4 53 12 7 72 72 0.0

Total 11 164 2 134 48 13 139 55 566 120 50 736 719 2.4

60-64

Male 10 139 3 77 38 13 101 56 437 95 39 571 537 6.3

Female 0 8 0 3 3 2 9 1 26 3 1 30 21 42.9

Total 10 147 3 80 41 15 110 57 463 98 40 601 558 7.7

65-69

Male 5 113 2 59 31 9 100 17 336 57 35 428 456 -6.1

Female 0 0 0 0 1 0 2 0 3 2 0 5 4 25.0

Total 5 113 2 59 32 9 102 17 339 59 35 433 460 -5.9

70+

Male 4 242 2 75 57 10 174 34 598 59 47 704 646 9.0

Female 0 3 0 1 0 0 2 0 6 0 1 7 9 -22.2

Total 4 245 2 76 57 10 176 34 604 59 48 711 655 8.5

Total

Male 75 1491 25 895 383 85 1191 410 4555 718 306 5579 5464 2.1

Female 10 191 3 110 55 10 195 50 624 102 42 768 717 7.1

Total 85 1682 28 1005 438 95 1386 460 5179 820 348 6347 6181 2.7

% of active Fellows under 55 years

%

Male 61.3 56.8 64.0 62.3 56.1 47.1 58.5 61.5 58.6 55.6 46.4 57.6 58.2 -1.0

Female 90.0 86.9 100.0 89.1 81.8 80.0 83.1 90.0 85.9 83.3 78.6 85.2 85.2 -0.1

Total 64.7 60.2 67.9 65.3 59.4 50.5 62.0 64.6 61.9 59.0 50.3 60.9 61.3 -0.6

Note: Data excludes OB & GYN and OPH.


123



TABLE WFD.4 – Active Australian RACS Fellows by specialty and age

Age group(years) CAR GEN NEU ORT OTO PAE PLA URO VAS

Total 2017

Total 2016

% Change

16/17

<35

Male 2 60 4 39 8 1 10 10 10 144 148 -2.7

Female 0 33 0 4 7 3 3 8 3 61 62 -1.6

Total 2 93 4 43 15 4 13 18 13 205 210 -2.4

35-39

Male 10 121 12 121 32 2 26 46 16 386 410 -5.9

Female 3 67 4 9 19 3 10 9 4 128 120 6.7

Total 13 188 16 130 51 5 36 55 20 514 530 -3.0

40-44

Male 17 243 39 227 68 9 67 62 27 759 753 0.8

Female 2 70 6 15 17 4 18 13 7 152 146 4.1

Total 19 313 45 242 85 13 85 75 34 911 899 1.3

45-49

Male 33 204 48 230 72 10 67 77 32 773 729 6.0

Female 4 59 11 8 10 3 13 9 3 120 106 13.2

Total 37 263 59 238 82 13 80 86 35 893 835 6.9

50-54

Male 35 184 34 148 51 13 57 58 29 609 601 1.3

Female 1 27 8 10 8 4 9 6 2 75 67 11.9

Total 36 211 42 158 59 17 66 64 31 684 668 2.4

55-59

Male 25 141 24 175 33 7 49 45 14 513 491 4.5

Female 3 22 1 5 5 8 6 1 2 53 54 -1.9

Total 28 163 25 180 38 15 55 46 16 566 545 3.9

60-64

Male 22 138 19 122 42 11 30 37 16 437 416 5.0

Female 0 11 1 4 1 2 5 0 2 26 17 52.9

Total 22 149 20 126 43 13 35 37 18 463 433 6.9

65-69

Male 15 127 13 96 29 6 17 20 13 336 353 -4.8

Female 1 1 0 0 0 0 1 0 0 3 3 0.0

Total 16 128 13 96 29 6 18 20 13 339 356 -4.8

70+

Male 17 229 24 135 68 6 57 37 25 598 557 7.4

Female 0 2 1 0 0 1 2 0 0 6 8 -25.0

Total 17 231 25 135 68 7 59 37 25 604 565 6.9

Total

Male 176 1447 217 1293 403 65 380 392 182 4555 4458 2.2

Female 14 292 32 55 67 28 67 46 23 624 583 7.0

Total 190 1739 249 1348 470 93 447 438 205 5179 5041 2.7


%

Male 55.1 56.1 63.1 59.2 57.3 53.8 59.7 64.5 62.6 58.6 59.2 -1.0

Female 71.4 87.7 90.6 83.6 91.0 60.7 79.1 97.8 82.6 85.9 85.9 0.0

Total 56.3 61.4 66.7 60.2 62.1 55.9 62.6 68.0 64.9 61.9 62.3 -0.7

Note: Data excludes OB & GYN and OPH.


124



TABLE WFD.5 – Active New Zealand RACS Fellows by specialty and age

Age group(years) CAR GEN NEU ORT OTO PAE PLA URO VAS

Total 2017

Total 2016

% Change

16/17

<35

Male 2 17 0 9 0 0 0 3 1 32 36 -11.1

Female 0 3 0 1 1 0 0 0 0 5 11 -54.5

Total 2 20 0 10 1 0 0 3 1 37 47 -21.3

35-39

Male 2 22 0 20 5 0 2 7 1 59 53 11.3

Female 1 9 0 2 4 0 4 1 1 22 16 37.5

Total 3 31 0 22 9 0 6 8 2 81 69 17.4

40-44

Male 2 16 3 39 6 2 6 7 2 83 89 -6.7

Female 0 10 0 3 7 0 5 3 0 28 27 3.7

Total 2 26 3 42 13 2 11 10 2 111 116 -4.3

45-49

Male 4 34 4 43 9 1 12 6 2 115 112 2.7

Female 0 8 0 4 2 0 2 1 0 17 12 41.7

Total 4 42 4 47 11 1 14 7 2 132 124 6.5

50-54

Male 3 30 5 35 14 2 9 10 2 110 109 0.9

Female 1 7 0 1 1 0 1 2 0 13 12 8.3

Total 4 37 5 36 15 2 10 12 2 123 121 1.7

55-59

Male 4 29 2 39 10 5 8 7 4 108 111 -2.7

Female 1 4 1 3 1 2 0 0 0 12 12 0.0

Total 5 33 3 42 11 7 8 7 4 120 123 -2.4

60-64

Male 8 23 1 27 20 2 5 5 4 95 84 13.1

Female 0 0 0 1 1 0 1 0 0 3 3 0.0

Total 8 23 1 28 21 2 6 5 4 98 87 12.6

65-69

Male 3 22 3 18 4 0 3 4 0 57 61 -6.6

Female 0 0 0 0 1 1 0 0 0 2 1 100.0

Total 3 22 3 18 5 1 3 4 0 59 62 -4.8

70+

Male 0 15 2 22 8 1 6 4 1 59 48 22.9

Female 0 0 0 0 0 0 0 0 0 0 0 –

Total 0 15 2 22 8 1 6 4 1 59 48 22.9

Total

Male 28 208 20 252 76 13 51 53 17 718 703 2.1

Female 3 41 1 15 18 3 13 7 1 102 94 8.5

Total 31 249 21 267 94 16 64 60 18 820 797 2.9


%

Male 46.4 57.2 60.0 57.9 44.7 38.5 56.9 62.3 47.1 55.6 56.8 -2.1

Female 66.7 90.2 0.0 73.3 83.3 0.0 92.3 100.0 100.0 83.3 83.0 0.4

Total 48.4 62.7 57.1 58.8 52.1 31.3 64.1 66.7 50.0 59.0 59.8 -1.4


125



TABLE WFD.6 – Active Australian RACS Fellows by RRMA code and specialty

Speciality M1 M2 R1 R2 R3 Rem1 Rem2Total 2017

% In M1/M2

2017Total2016

% In M1/M2

2016

% Change in M1/M2

16/17

CAR 170 18 0 2 0 0 0 190 98.9 189 98.9 0.0

GEN 1225 164 171 137 37 4 1 1739 79.9 1684 80.0 -0.2

NEU 222 24 1 2 0 0 0 249 98.8 242 99.2 -0.4

ORT 998 130 125 82 12 1 0 1348 83.7 1313 83.7 0.0

OTO 362 45 44 15 4 0 0 470 86.6 460 86.1 0.6

PAE 79 12 2 0 0 0 0 93 97.8 95 97.9 -0.1

PLA 389 31 15 6 5 0 1 447 94.0 440 94.5 -0.6

URO 327 41 53 15 2 0 0 438 84.0 423 84.6 -0.7

VAS 161 25 15 4 0 0 0 205 90.7 195 90.8 -0.1

Total 3933 490 426 263 60 5 2 5179 85.4 5041 85.6 -0.2

Note: Data Excludes OB & GYN and OPH

TABLE WFD.7 – Active Australian RACS Fellows by RRMA and location

Region M1 M2 R1 R2 R3 Rem1 Rem2Total 2017

% In M1/M2

2017Total2016

% In M1/M2

2016

% Change in M1/M2

16/17

ACT 84 0 1 0 0 0 0 85 98.8 84 97.6 1.2

NSW 1205 199 134 109 33 0 2 1682 83.5 1652 84.0 -0.7

NT 4 24 0 0 0 0 0 28 100.0 27 96.2 4.0

QLD 564 199 182 54 3 3 0 1005 75.9 965 76.4 -0.6

SA 422 1 3 9 3 0 0 438 96.6 424 96.5 0.1

TAS 57 1 29 7 1 0 0 95 61.1 94 61.7 -1.0

VIC 1170 66 77 58 15 0 0 1386 89.2 1343 89.1 0.1

WA 427 0 0 26 5 2 0 460 92.8 452 92.3 0.6

Total 3933 490 426 263 60 5 2 5179 85.4 5041 85.6 -0.2


TABLE WFD.8 – Active Australian RACS Fellows by RRMA and age group

Age Group (years) M1 M2 R1 R2 R3 Rem1 Rem2

Total 2017

% In M1/M2

2017Total2016

% In M1/M2

2016

% Change in M1/M2

16/17

<35 166 21 12 5 1 0 0 205 91.2 210 91.0 0.2

35-39 414 43 28 24 5 0 0 514 88.9 530 90.4 -1.6

40-44 713 88 75 30 5 0 0 911 87.9 899 89.2 -1.4

45-49 685 102 62 37 6 1 0 893 88.1 835 87.1 1.2

50-54 494 71 71 37 10 1 0 684 82.6 668 80.4 2.7

55-59 403 49 72 36 4 2 0 566 79.9 545 82.4 -3.1

60-64 348 40 37 31 5 1 1 463 83.8 433 81.3 3.1

65-69 235 29 37 32 6 0 0 339 77.9 356 79.5 -2.0

70+ 475 47 32 31 18 0 1 604 86.4 565 87.3 -1.0

Total 3933 490 426 263 60 5 2 5179 85.4 5041 85.6 -0.2



126



TABLE WFD.9 – Active RACS SET Trainees obtaining RACS Fellowship in 2017 by location of residence and specialty



CAR

Male 0 2 0 0 0 0 0 0 2 1 0 3

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 2 0 0 0 0 0 0 2 1 0 3

GEN

Male 1 16 1 5 4 0 15 2 44 9 1 54

Female 0 5 1 2 3 1 6 1 19 2 0 21

Total 1 21 2 7 7 1 21 3 63 11 1 75

NEU

Male 0 1 0 2 0 1 3 0 7 0 3 10

Female 0 1 0 0 0 0 0 0 1 0 0 1

Total 0 2 0 2 0 1 3 0 8 0 3 11

ORT

Male 0 15 0 7 3 1 10 4 40 6 2 48

Female 0 2 0 2 1 0 0 0 5 1 0 6

Total 0 17 0 9 4 1 10 4 45 7 2 54

OTO

Male 0 3 0 2 2 0 2 0 9 2 0 11

Female 0 1 0 2 0 0 2 0 5 1 0 6

Total 0 4 0 4 2 0 4 0 14 3 0 17

PAE

Male 0 0 0 0 0 0 0 0 0 0 1 1

Female 0 0 0 0 0 0 1 0 1 0 0 1

Total 0 0 0 0 0 0 1 0 1 0 1 2

PLA

Male 0 1 0 2 1 0 5 0 9 1 0 10

Female 0 1 0 0 1 0 1 0 3 1 2 6

Total 0 2 0 2 2 0 6 0 12 2 2 16

URO

Male 0 2 0 5 0 1 3 0 11 2 2 15

Female 0 1 0 0 0 0 2 0 3 0 0 3

Total 0 3 0 5 0 1 5 0 14 2 2 18

VAS

Male 0 2 0 1 1 0 1 0 5 0 1 6

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 2 0 1 1 0 1 0 5 0 1 6

Total

Male 1 42 1 24 11 3 39 6 127 21 10 158

Female 0 11 1 6 5 1 12 1 37 5 2 44

Total 1 53 2 30 16 4 51 7 164 26 12 202


127



TABLE WFD.10 – Active International Medical Graduates obtaining RACS Fellowship in 2017 by location of residence and specialty



CAR

Male 0 0 0 1 0 0 0 0 1 0 0 1

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 0 0 1 0 0 0 0 1 0 0 1

GEN

Male 0 1 1 4 2 0 3 1 12 1 1 14

Female 0 0 0 4 0 0 1 0 5 0 0 5

Total 0 1 1 8 2 0 4 1 17 1 1 19

NEU

Male 0 1 0 0 0 0 0 0 1 0 0 1

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 1 0 0 0 0 0 0 1 0 0 1

ORT

Male 0 1 0 3 0 0 2 0 6 0 0 6

Female 0 0 0 0 0 0 1 0 1 0 0 1

Total 0 1 0 3 0 0 3 0 7 0 0 7

OTO

Male 0 0 0 1 0 0 0 0 1 0 0 1

Female 0 0 0 0 1 0 0 0 1 0 0 1

Total 0 0 0 1 1 0 0 0 2 0 0 2

PAE

Male 0 0 0 1 0 0 1 0 2 0 1 3

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 0 0 1 0 0 1 0 2 0 1 3

PLA

Male 0 1 0 0 0 0 0 0 1 0 0 1

Female 0 0 0 0 1 0 0 0 1 0 0 1

Total 0 1 0 0 1 0 0 0 2 0 0 2

URO

Male 0 0 0 0 0 1 1 0 2 0 0 2

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 0 0 0 0 1 1 0 2 0 0 2

VAS

Male 0 0 0 1 1 0 0 0 2 0 0 2

Female 0 0 0 0 0 0 0 0 0 0 0 0

Total 0 0 0 1 1 0 0 0 2 0 0 2

Total

Male 0 4 1 11 3 1 7 1 28 1 2 31

Female 0 0 0 4 2 0 2 0 8 0 0 8

Total 0 4 1 15 5 1 9 1 36 1 2 39


128



TABLE WFD.11 – Total number of SET Trainees and International Medical Graduates obtaining RACS Fellowship by specialty (2008 – 2017)

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CAR

Male 10 6 5 11 5 15 4 7 10 4

Female 0 0 0 1 1 0 0 2 2 0

Total 10 6 5 12 6 15 4 9 12 4

GEN

Male 62 47 63 54 64 57 55 65 74 68

Female 14 23 13 12 30 17 20 25 33 26

Total 76 70 76 66 94 74 75 90 107 94

NEU

Male 14 7 12 6 9 5 6 18 9 11

Female 4 2 0 0 0 3 6 0 1 1

Total 18 9 12 6 9 8 12 18 10 12

ORT

Male 41 67 49 60 59 61 38 60 66 54

Female 2 3 2 8 2 4 3 4 3 7

Total 43 70 51 68 61 65 41 64 69 61

OTO

Male 9 12 16 21 12 15 14 14 13 12

Female 4 5 6 5 7 6 11 4 2 7

Total 13 17 22 26 19 21 25 18 15 19

PAE

Male 3 2 3 2 4 2 4 5 1 4

Female 0 1 1 3 2 1 4 1 3 1

Total 3 3 4 5 6 3 8 6 4 5

PLA

Male 19 7 7 18 22 14 13 11 15 11

Female 4 3 8 4 1 5 5 8 7 7

Total 23 10 15 22 23 19 18 19 22 18

URO

Male 15 12 15 22 19 22 21 14 17 17

Female 3 3 3 3 3 5 6 1 6 3

Total 18 15 18 25 22 27 27 15 23 20

VAS

Male 4 11 5 10 5 4 11 9 5 8

Female 1 1 0 2 2 2 4 1 2 0

Total 5 12 5 12 7 6 15 10 7 8

Total

Male 177 171 175 204 199 195 166 203 210 189

Female 32 41 33 38 48 43 59 46 59 52

Total 209 212 208 242 247 238 225 249 269 241

FIGURE WFD.1 – Total annual number of SET Trainees and International Medical Graduates obtaining RACS Fellowship (2008–2017)

Male Female

300

250

200

150

100

50

02008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Number ofnew Fellows

Year admitted into RACS Progress Report 2018 Appendices

129



TABLE WFD.12 – Ratio of active Australian and New Zealand RACS Fellows per population by location

No. of surgeonsRatio of surgeons

per 10,000 population Population

ACT 85 2.1 410,301

NSW 1682 2.1 7,861,068

NT 28 1.1 246,105

QLD 1005 2.0 4,928,457

SA 438 2.5 1,723,548

TAS 95 1.8 520,877

VIC 1386 2.2 6,323,606

WA 460 1.8 2,580,354

AUS 5179 2.1 24,598,900

NZ 820 1.7 4,785,100

Data excludes Obstetrics & Gynaecology and Ophthalmology Fellows.

Population Source: Australian Bureau of Statistics website www.abs.gov.au and Statistics New Zealand website www.stats.govt.nz and is accurate as at December 2017.

TABLE WFD.13 – Ratio of active Australian and New Zealand RACS Fellows per population aged 65 years or older by location

No. of surgeonsRatio of surgeons per 1,000

population ≥ 65 yearsPopulation over ≥ 65 years

ACT 82 1.6 51,183

NSW 1647 1.3 1,252,461

NT 28 1.6 17,807

QLD 991 1.3 741,868

SA 432 1.4 311,424

TAS 93 0.9 100,346

VIC 1363 1.4 959,072

WA 451 1.3 359,901

AUS 5087 1.3 3,794,800

NZ 804 1.1 723,000

Data excludes the surgical specialties of Paediatric surgery, Obstetrics & Gynaecology and Ophthalmology. Population Source: Australian Bureau of Statistics website www.abs.gov.au and Statistics New Zealand website www.stats.govt.nz and is accurate as at December 2017.


130

SECTION SIX PROFESSIONAL STANDARDS AND DEVELOPMENT


EXPLANATORY NOTESAll active Fellows have a requirement to participate in either the College Continuing Professional Development (CPD) program or in another CPD program that is approved by the College as meeting its standards for CPD. CPD program data is submitted to RACS in the year following participation, therefore the latest available 2016 CPD participation data are reported in Tables CPD.1 to CPD.5. Ophthalmologists and obstetricians and gynaecologists who held RACS Fellowship have been included.

DATA SUMMARYIn 2016 there were 6,321 Fellows participating in the College CPD or other CPD approved program including Ophthalmologists and Obstetricians and Gynaecologists who hold a RACS Fellowship.

In 2016 99.6% of Fellows complied with the RACS CPD Program, representing a -0.3% reduction in compliance from 2015. Failure to comply constitutes a breach of the College’s Code of Conduct and is managed via the RACS Sanctions Policy.

To facilitate the maintenance of surgical competence of Fellows, RACS provides professional development activities that are tailored to the specific needs of Fellows. These activities address the skills and knowledge required in each of the College’s nine surgical competencies.

During 2017, the Professional Development Department delivered activities to a total of 3725 participants (3365 Fellows, 85 Trainees, 40 IMGs and 235 medical practitioners and health professionals), more than double compared to 2016. The increase is largely due to the delivery of 109 Foundation Skills for Surgical Educators (FSSE) courses as part of the RACS Building Respect, Improving Patient Safety Action Plan.

TABLE CPD.1 – Participation in RACS CPD program 2014 – 2016 by specialty

2014 2015 2016

Specialty

Total required to participate

Total compliant

% compliant


Total compliant

% compliant


Total compliant

% compliant

CAR 218 218 100.0 229 229 100.0 236 234 99.2

GEN 1903 1903 100.0 1943 1942 99.9 2019 2014 99.8

NEU 267 267 100.0 281 281 100.0 286 285 99.7

ORT 505 505 100.0 525 525 100.0 544 544 100.0

OTO 546 546 100.0 561 561 100.0 571 568 99.5

PAE 129 129 100.0 129 129 100.0 128 128 100.0

PLA 488 488 100.0 503 503 100.0 515 511 99.2

URO 475 475 100.0 483 483 100.0 498 497 99.8

VAS 207 207 100.0 214 214 100.0 222 219 98.6

Sub Total 4738 4738 100.0 4868 4867 99.9 5019 5000 99.6

OB & GYN and OPH 8 8 100.0 7 7 100.0 6 6 100.0

Total 4746 4746 100.0 4875 4874 99.9 5025 5006 99.6


131

SECTION 6: PROFESSIONAL STANDARDS AND DEVELOPMENT


TABLE CPD.2 – Participation in RACS CPD program 2014 – 2016 by region

2014 2015 2016

Specialty


Total compliant

%compliant


Total compliant

%compliant


Total compliant

%compliant

ACT 62 62 100.0 62 62 100.0 67 67 100.0

NSW 1246 1246 100.0 1283 1283 100.0 1323 1316 99.5

NT 26 26 100.0 25 25 100.0 24 24 100.0

SA 330 330 100.0 343 343 100.0 350 349 99.7

QLD 748 748 100.0 768 768 100.0 801 799 99.8

TAS 76 76 100.0 77 77 100.0 76 76 100.0

VIC 1050 1050 100.0 1085 1084 99.9 1122 1115 99.4

WA 365 365 100.0 377 377 100.0 384 383 99.7

AUS Total 3903 3903 100.0 4020 4019 99.9 4147 4129 99.6

NZ 529 529 100.0 535 535 100.0 555 554 99.8

O/S 314 314 100.0 320 320 100.0 323 323 100.0

Total 4746 4746 100.0 4875 4874 99.9 5025 5006 99.6

All active Fellows have a requirement to participate in either the College CPD program or in another CPD program approved by the College as meeting its standards for CPD. In 2016 there were 6321 Fellows participating in the College CPD or other CPD approved program. Ophthalmologists and Obstetricians and Gynaecologists who held RACS Fellowship have been included.

TABLE CPD.3 – Fellow participation in RACS and other CPD programs in 2016

College CPD ProgramsNumber of

participating Fellows % of

participating Fellows

Royal Australasian College of Surgeons 5025 79.5

Australian Orthopaedic Association 830 13.1

New Zealand Orthopaedic Association 235 3.7

Royal Australian College of General Practitioners 12 0.2

Royal Australian and New Zealand College of Ophthalmologists 213 3.4

Royal Australian and New Zealand College of Obstetricians and Gynaecologists 1 0.0

Other College CPD program 5 0.1

Total 6321 100.0

TABLE CPD.4 – Participation in RACS CPD program in 2016 by program category and specialty

Fellows’ specialty

CPD category CAR GEN NEU OPH ORT OTO PAE PLA URO VAS Total % Total

Operative practice in hospitals or day surgery units

201 1790 252 5 507 511 121 477 471 206 4541 90.4

Operative procedures in rooms only 0 8 0 1 0 3 0 2 2 0 16 0.3

Operative Practice as a locum only 0 25 0 0 5 8 0 1 3 0 42 0.8

Clinical consulting practice only 5 52 22 0 20 36 1 15 6 5 162 3.2

Other practice type 30 144 11 0 12 13 6 20 17 11 264 5.3

Total 236 2019 285 6 544 571 128 515 499 222 5025 100.0


132

SECTION SIX PROFESSIONAL STANDARDS AND DEVELOPMENT


TABLE CPD.5 – Registrations in RACS MOPS program in 2016

AUS NZ O/STotal

registrations

Persons 9 10 0 19

IMGs 2 65 1 68

Total 11 75 1 87

Note: The category ‘Persons’ are surgeons who do not have a FRACS and are not on a pathway to Fellowship

TABLE CPD.6 – Professional Development participation by location and status

Location Fellow SET Trainee IMG

Medical practitioners and

health workers Total 2017 Total 2016% Change

16/17

ACT 28 5 0 2 35 31 12.9

NSW 888 24 1 43 956 255 274.9

NT 19 1 0 0 20 24 -16.7

QLD 447 15 8 58 528 260 103.1

SA 208 5 1 12 226 98 130.6

TAS 70 0 0 3 73 20 265.0

VIC 887 20 2 82 991 316 213.6

WA 225 1 0 6 232 115 101.7

AUS 2772 71 12 206 3061 1119 173.5

NZ 577 14 28 20 639 187 241.7

O/S 16 0 0 9 25 23 8.7

Total 3365 85 40 235 3725 1329 180.3

TABLE CPD.7 – Professional Development participation by specialty and status

SpecialtyTotal2017

Total 2016

% Change 16/17

CAR 99 58 70.7

GEN 1278 413 209.4

NEU 155 67 131.3

ORT 552 156 253.8

OTO 359 116 209.5

PAE 114 31 267.7

PLA 283 0* –

URO 364 83 338.6

VAS 154 53 190.6

Sub Total 3358 977 243.7

OPH 7 4 75.0

SET 85 49 73.5

IMG 40 24 66.7

Medical practitioners and health workers 235 275 -14.5

Total 3725 1329 180.3

*Data unavailable at time of publication


133


SECTION SEVEN ACTIVITIES OF RACS GLOBAL HEALTH

EXPLANATORY NOTESRACS Global Health programs encapsulate the College’s on-going commitment in:

• partnering with Southeast Asia and Pacific neighbours to provide access to much needed health services and assist in the development of medical and surgical capacity; and

• advocating for access to safe surgery and anaesthesia within the global health agenda.

PACIFIC ISLANDS PROGRAM (PIP) The Australian Government support to this initiative started in 1995 under a series of funding contracts with RACS as the managing contractor. The current iteration of PIP has activities contributing to a new overarching Pacific Regional Clinical Services and Workforce Improvement Program. The PIP is one of three components implemented under this regional program, and was the first to be contracted, with funding & activity implementation from 2016 to 2021. Other components will be managed by Fiji National University and the Secretariat of the Pacific Community. The new program design will continue the provision of specialist clinical services while also providing the platform for supporting continuing professional development of health workforce and improving clinical systems. The PIP activities are delivered by volunteer medical practitioners as well as nurses and allied health professionals.

The activities implemented throughout 2017 were at the specific request and/or in consultation with the recipient countries, including: Cook Islands, Fiji, Kiribati, Federated States of Micronesia, Nauru, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu.

AUSTRALIA TIMOR-LESTE PROGRAM OF ASSISTANCE FOR SECONDARY SERVICES PHASE II (ATLASS II)The ATLASS II Program is designed to contribute to the Government of Timor-Leste’s overall aim of producing a comprehensive, high quality health service for the benefit of the Timorese population. The program’s main component is dedicated to building the capacity of the Timorese health workforce through a range of formal and informal training, mentoring and support activities. In 2014, the program commenced the delivery of a bridging/foundation program for East Timorese who completed their medical undergraduate qualification in Cuba. Upon completion of the Foundation Year, the trainees would either continue to pursue specialist post graduate training or mobilised for delivery of health services in the districts.

By the end of 2017, 60 Timorese doctors have completed the Foundation Year, of which 27 Timorese candidates have completed their Post Graduate Diploma program in Family Medicine, Paediatrics, Anaesthetics, Surgery or Ophthalmology, and 32 currently enrolled in the diploma program. Thirty new trainees are currently undertaking the Foundation Year training program. The Masters of Medicine in Paediatrics also continued in 2017 with 10 trainees enrolled, completing their final assessments in June or December 2017.

EAST TIMOR EYE PROGRAM (ETEP) The East Timor Eye Program (ETEP), established in July 2000, is a program targeted at delivering eye-care services to Timor-Leste. The key objectives are to help Timor-Leste achieve self-sufficiency in the provision of eye care by 2020 and to work towards completely eradicating preventable blindness by 2025. The program will achieve this goal through training local surgeons and health practitioners and strengthening infrastructure, thereby considerably increasing the availability of eye health services in Timor-Leste.

The national eye care services are now delivered under the Department of Ophthalmology of Hospital Nasional Guido Valadares. In 2017, the ETEP continued to support the delivery of the Post Graduate Diploma of Ophthalmology in Timor Leste. Three candidates completed the diploma program, of which two have proceeded to commence in a Masters of Medicine in Ophthalmology program.

HEALTH SERVICES DEVELOPMENT PROGRAM IN PAPUA AND WEST PAPUA, INDONESIAThe Health Services Development Program aims to improve health services and workforce development through provision of medical education in Papua and West Papua. Health education priorities identified by in-country partners include appropriate trauma, burns and pain management, nurse training and clinical, anaesthesia and pathology services.

In 2017, the program supported the delivery of the Essential Pain Management and Emergency Management of Severe Burns courses. In collaboration with the College of Surgeons Indonesia, Basic Surgical Skills, nurse training and trauma training was also provided to health care practitioners, including many from the remote areas of the Papua and West Papua provinces.


134


SUMBA EYE PROGRAM (SEP), NUSA TENGARA TIMUR (NTT) The Sumba Eye Program (SEP) was established in 2008 to provide eye care for the people of Sumba island, Nusa Tenggara Timur, Indonesia. Services comprise screening for eye diseases, eye operations as well as optometry. The SEP team has been concentrating on expanding the program’s training and capacity building component to promote sustainability.

In 2017, the Australian team delivered two clinical and training visits in collaboration with Sumba Foundation and regional ophthalmologists. The team worked alongside and mentored two Sumbanese eye care nurses to create a self-sustainable local medical team for the Sumbanese and the greater area of Nusa Tenggara Timur. The nurses undertook a training visit to Melbourne in March 2017.

MYANMAR PROGRAMS In partnership with the Myanmar Medical Association, Ministry of Health, and University of Medicine 1, RACS continues to support emergency medicine and primary trauma care (PTC) training in Myanmar. Building upon the success of the PTC program, the College worked closely with the Myanmar medical institutions, Australian College of Emergency Medicine and individual specialists from Hong Kong to develop and deliver a Post-Graduate Diploma in Emergency Medicine Course in Myanmar. In 2017, a team of four volunteer RACS instructors delivered 3 Surgical Skills training courses in Yangon and Mandalay in February and August. This was the fifth Surgical Skills Program delivered in Myanmar.

KIRIBATI EYE CLINIC SUPPORT PROJECTThe Kiribati Eye Clinic Support Project is an initiative jointly funded by the Australian Government through the Australian NGO Cooperation Program, and the RACS Foundation for Surgery. At the request of the i-Kiribati Ministry of Health and Medical Services, this short term project is designed to assist the i-Kiribati Ophthalmologist to establish a functional eye clinic at the main hospital in Kiribati, Tungaru Central Hospital.

The project was completed in 2017, with final equipment purchased and delivered to the clinic, and an Australian volunteer equipment technician mobilised to Kiribati to train local bio-med technicians on the service and maintenance of optic equipment. The project is designed to assist Kiribati realise the full potential of their trained Ophthalmologist and eye care nurses, to deliver eye care services independently, including reducing the incidence of vision impairment in the country.

ASIA PAEDIATRIC SURGERY EDUCATION PROGRAM (APSEP)The APSEP is an initiative jointly funded by the Australian Government through the Australian NGO Cooperation Program, the Monash Children’s Hospital International and the RACS Foundation for Surgery. The APSEP aims to support the education and development of Vietnamese, Cambodian and Myanmar surgeons through in-country teaching clinics delivered by volunteer visiting specialist teams and training attachments and attendance to courses in Australia or other appropriate locations. In 2017, one visit was undertaken by the APSEP team to Myanmar, focusing on paediatric burns and trauma training.

ANAESTHESIA TRAINING CENTRE SUPPORT PROJECTThe Anaesthesia Training Centre project is an initiative jointly funded by the Australian Government through the Australian NGO Cooperation Program, and the RACS Foundation for Surgery. This project seeks to enhance the quality and safety of anaesthesia training and hospital services by supporting the Solomon Islands Ministry of Health and Medical Services to enhance infrastructure and anaesthetic equipment in the National Referral Hospital in Honiara. The project will support the procurement of a laryngoscope and bronchoscope; alongside supporting the training and use of these pieces of equipment within Solomon Islands to strengthen in-country anaesthesia training.

ROWAN NICKS FELLOWSHIPS AND SCHOLARSHIPSThe Rowan Nicks fellowships and scholarships are offered annually to young surgeons who have been identified as surgical or medical leaders of the future. These opportunities are tenable in an institution where recipients will learn the craft of surgery and also become involved in teaching, research and administration.

WEARY DUNLOP BOONPONG EXCHANGE FELLOWSHIPThe Weary Dunlop Boonpong Fellowship Program is a collaboration between RACS and the Royal College of Surgeons of Thailand. The exchange program provides opportunities for Thai surgeons to undertake clinical attachments in Australian hospitals in their nominated field of interest.

SURGEONS INTERNATIONAL AWARDThe Surgeons International Award provides for doctors, nurses or other health professionals from underprivileged backgrounds to undertake short term visits to one or more Australian hospitals to acquire the knowledge, skills and contacts needed for the promotion of improved health services in the recipient’s own country.



135

SECTION 7: ACTIVITIES OF RACS GLOBAL HEALTH


TABLE GH.1 – RACS Global Health clinical visits

ProjectsNo. of

clinical visits Surgeons RACS Fellows

Anaesthetists, nurses &

other health care workers Consultations

Operations/ Procedures

PNG – Neurosurgery Visit 1 1 1 – 18 2

Timor Leste

ATLASS II * 7 3 2 8 3,583 886

East Timor Eye Program (ETEP)* 25 23 5 12 10,486 945

SUB TOTAL (EAST TIMOR) 32 26 7 20 14069 1831

Indonesia

Health Service Development – Papua & West Papua 1 2 2 4 8 5

Sumba Eye Program – Nusa Tengara Timur 2 3 2 7 1,920 126

SUB TOTAL (INDONESIA) 3 5 4 11 1928 131

Pacific Islands Projects (PIP)

Cook Islands 1 – – 1 70 14

Fiji 5 6 3 6 144 69

Kiribati 2 3 3 5 424 27

Federated States of Micronesia 2 2 2 4 170 23

Nauru 1 – – 2 76 –

Samoa 3 5 5 9 184 89

Solomon Islands 6 5 5 14 349 118

Tonga 3 3 3 4 97 47

Tuvalu 1 – – 2 242 –

Vanuatu 5 8 8 17 309 108

SUB TOTAL (PIP) 29 32 29 64 2065 495

TOTAL 2017 65 64 41 95 18080 2459

*ATLASS/ETEP consultations and operations/procedures statistics include output of East Timor-based long term advisers (General Surgeon, Anaesthetist, Paediatrician, Obstetrician/Gynaecologist, Internal Medicine and Ophthalmologist). ETEP figures include outputs of Timorese clinicians supported under ETEP

TABLE GH.2 – RACS Global Health non-clinical visits

CountrySurgical

workshops

Medical & allied health

workshopsNursing

workshops

Other assisting

programs Total

ATLASS II – 1 – – 1

East Timor 1 1 2

Papua – Indonesia 1 7 3 5 16

Myanmar 8 – – – 8

Indonesia – – – 2 2

Fiji 1 – – – 1

Nauru 1 – – – 1

Solomon Islands – 1 – – 1

Total 2017 12 9 3 8 32


136



TABLE GH.3 – International scholarships awarded to surgeons with hospital attachments in Australia, New Zealand or South East Asia

International Scholarships Programs

Country Location of Recipients:

No. of Surgeons Supported

No. Anaesthetists, nurses & other health care workers

supportedNo. Conferences/Courses

Attended by Recipients

Rowan Nicks UK 2 – 1

Surgeons International Myanmar 1 – –

Vietnam 3 – –

Weary Dunlop Boon Pong Thailand 4 – 1

Myanmar Scholarship Myanmar 1 – 1

TOTAL 2017 11 – 3

TABLE GH.4 – International travel and educational grants – support for conference attendance

Country Location of Recipients:

No. grants awarded

Tonga 1

Timor Leste 1

Nepal 1

Thailand 2

Bangladesh 1

China 2

Malaysia 1

Indonesia 3

TOTAL 2017 12


137


EXPLANATORY NOTESThe Conferences and Events Department is based in the External Affairs Division of the Royal Australasian College of Surgeons.

The Department manages surgical events on behalf of Fellows and medical professionals with a major annual event being the RACS Annual Scientific Congress. The 2017 Annual Scientific Congress (ASC) was held in Adelaide.

The Department strives to deliver conferences of high professional value, with strong perceptions of educative worth demonstrated through the positive feedback of RACS Fellows.

The Department tenders for several external events each year and also supports the RACS annual meetings held in New Zealand and Australian states and territories. In addition to the ASC, the Department successfully co-ordinated the following conferences and meetings in 2017:• ASOHNS Annual Scientific Meeting

• Developing a Career in Academic Surgery (DCAS) Course

• New Zealand Surgery 2017 Meeting

• Queensland Annual State Meeting

• WA/SA/NT Annual Scientific Meeting

• NSA Annual Scientific Meeting

• ANZHNCS Annual Scientific Meeting

• ANZSVS Conference

• Victorian Annual Surgical Meeting

• WA Surgeons Ball – Registrations Only

• The Alfred General Surgery Meeting

• ACT Annual Scientific Meeting

• SA HoodSweeney 2017 Royal Colleges Golf Day – Registrations Only

• SA Annual Dinner and Anstey Giles Lecture – Registrations Only

• ANZSCTS Annual Scientific Meeting

• Combined Sydney Colorectal Meeting

• ICOSET

TABLE C&E.1 – RACS Annual Scientific Congress attendance 2017

Attendee classification CAR GEN NEU ORT OTO PAE PLA URO VASTotal 2017

Total 2016

% Change 16/17

RACS Fellow 32 685 20 70 29 51 28 17 41 973 1146 -15.1

Honorary Fellow – – – – – – – – – 4 3 33.3

SET Trainee 27 116 1 1 5 13 2 2 1 168 178 -5.6

IMG – – – – – – – – – 10 15 -33.3

NON IMG/Trainee/Fellow – – – – – – – – – 631 717 -12.0

Total 59 801 21 71 34 64 30 19 42 1786 2059 -13.3

FIGURE C&E.1 – Total number of attendees at RACS Annual Scientific Congress (2010–2017)

SECTION EIGHT ACTIVITIES OF CONFERENCE AND EVENTS

RACS Fellows Honorary Fellow SET Trainee IMG Non IMG / Traninee / Fellow

2010 2011 2012 2013 2014 2016 20172015

Number of Attendees

Year of RACS Annual Scientific Congress

0

500

1000

1500

2000

2500


138

SECTION NINE ACTIVITIES OF RACS SKILLS AND EDUCATION CENTRE


EXPLANATORY NOTESThe RACS Skills & Education Centre’s major function is to ensure that surgeons and other health professionals have access to the facilities and technical support required for training in modern surgical skills and related areas. The Centre provides a well-equipped and flexible skills laboratory and multi-purpose training and conference areas in which regular surgical educational courses are conducted for Trainees and Fellows of the College.

The Centre’s key components are the Skills Laboratory, the Level 1 Lecture Room, the Level 2 Training Area, and the Hughes Room. The Skills Laboratory is a ‘wet’ workshop area, while the other rooms are meeting/conference areas.

The facilities are available for use on a seven day per week basis for RACS (internal) and outside organisations (external). The aim is to maximise use of the rooms by external hirers when not booked by RACS users. The Skills Centre facilities accommodated a total of 2,050 room bookings including 1,475 bookings for RACS staff, Fellows, and Trainees along with 575 room bookings for External events attended by over 20,000 people. College-wide, the Skills Centre and Event Services team dealt with 4,274 individual room bookings in 2017.

DATA SUMMARYSkills Laboratory WorkshopsTable SEC.1 shows the number of workshops and training events conducted in the Skills Laboratory in 2017. Workshops are separated into two categories: RACS workshops include those for Fellows and Trainees including mandatory courses such as ASSET, specialty training programs, and optional skills courses. External events include workshops conducted on behalf of other medical specialty Colleges and a range of other groups.

Workshops by Surgical SpecialtyFigure SEC.1 provides a breakdown by specialty of the surgical educational workshops conducted for Fellows and Trainees. Note that a number of these fall into the External Workshops category shown in Table SEC.1. ‘Not specialty specific’ indicates that the workshop covered skills relevant to multiple surgical specialties, for example the ASSET fundamental skills workshop.

Skills Laboratory UsageFigure SEC.2 shows the percentage of available days of the week when the Skills Laboratory is in use for internal and external workshops. This includes time when workshops are being conducted along with preparation, set-up, pack-down, cleaning and decontamination directly associated with those workshops.

Workshop ParticipantsTable SEC.2 shows the cumulative number of participants (including faculty) in Skills Laboratory workshops throughout 2017.

Surgical Workshop Participants by SpecialtyFigure SEC.3 shows the cumulative number of participants from each surgical specialty who took part in Skills Laboratory workshops in 2017.

Total Workshop Participants by ProfessionFigure SEC.4 provides a breakdown by profession of participants in all of the Skills Laboratory workshops in 2017. ‘Other’ covers a wide range of workshop attendees including simulation educators, medical postgraduates, intensivists, ophthalmologists, haematologists, anatomists, veterinarians, product specialists, etc.


139

SECTION 9: ACTIVITIES OF RACS SKILLS AND EDUCATION CENTRE


TABLE SEC.1 – Number of workshops held in the Skills Laboratory in 2017

Attendee classification JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DECTotal2017

Total 2016

% Change

16/17

RACS workshops 1 2 5 2 4 3 6 3 4 7 4 3 44 41 7

External workshops 0 2 14 3 2 4 1 3 8 5 5 2 49 49 0

Total 1 4 19 5 6 7 7 6 12 12 9 5 93 90 3

FIGURE SEC.1 – Surgical workshops held in the Skills Laboratory by specialty (either RACS or external workshop)

FIGURE SEC.2 – Occupancy of the Skills Laboratory on a seven-day basis in 2017

25

20

15

10

5

0CAR GEN NEU ORT OTO PAE PLA URO VAS Not

specialtyspecific

Number ofworkshops

255

200

155

100

55

00CAR GEN NEU ORT OTO PAE PLA URO VA

College Workshops External Workshops

90

80

70

60

50

40

30

20

10

0

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Occupancy(%)

Note: Occupancy is measured by half-day blocks as a percentage of all available blocks for the year.


140

SECTION NINE ACTIVITIES OF RACS SKILLS AND EDUCATION CENTRE


TABLE SEC.2 – Number of Skills Laboratory workshop participants in 2017

Attendee classification JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DECTotal2017

Total 2016

% Change

16/17

RACS participants 22 70 83 87 140 85 171 126 106 181 58 48 1177 1153 2

External participants 0 62 222 75 38 69 44 28 93 117 164 22 934 1020 -8

Total 22 132 305 162 178 154 215 154 199 298 222 70 2111 2173 -3

FIGURE SEC.3 – Total number of Skills Laboratory surgical workshop participants in 2017 by specialty

FIGURE SEC.4 – Total number of Skills Laboratory workshop participants in 2017 by profession

CAR GEN NEU ORT OTO PAE PLA URO VAS

Number of participants

400

350

300

250

200

150

100

50

0

1,200

1,000

800

600

400

200

0Surgeon GP Med Student OB & GYN Anaesthetist Nurse Emergency Dentist

Number of participants

Other


141


APPENDIX A

APPENDIX A: DEFINITIONS FOR REGIONAL, RURAL AND RRMA DATARRMA CodesThe Rural, Remote and Metropolitan Area code (RRMA) is used to help classify healthcare facilities across Australia according to the types of communities they serve. The RRMA code divides Australia into areas according to city status, population, rurality and remoteness.

Use of Postcode to Determine RegionThe allocation of Fellows to regions and RRMA classification is determined by the postcode from each Fellow’s preferred mailing address as of December 2017. The last known mailing address was used if the current address was unknown.

Rural Remote and Metropolitan Areas Classification & Population Size

RRMA CODE DEFINITION POPULATION SIZE EXAMPLES

M1 Capital cities > 500,000 Sydney, Melbourne, Brisbane, Perth, Adelaide, Hobart, Darwin and Canberra

M2 Other metropolitan centres 100,000 – 499,999 Newcastle, Wollongong, Queanbeyan (part of Canberra-Queanbeyan), Geelong, Gold Coast-Tweed Heads, Townsville

R1 Large rural cities 25,000 – 99,999 Albury-Wodonga, Dubbo, Lismore, Orange, Port Macquarie, Tamworth, Wagga Wagga, (NSW); Ballarat, Bendigo, Shepparton-Mooroopna (VIC); Bundaberg, Cairns, Mackay, Maroochydore-Mooloolaba, Rockhampton, Toowoomba (QLD), Whyalla (SA); and Launceston (TAS)

R2 Small rural centres 10,000 – 24,999 Armidale, Mildura, Hervey Bay, Mount Gambier, Bunbury, Devonport

R3 Other rural centres < 10,000 Cowra Shire, Temora Shire, Guyra Shire (NSW); Ararat Shire, Cobram Shire (Vic); Cardwell Shire, Whitsunday Shire (Qld); Barossa, Pinnaroo (SA); Moora Shire, York Shire (WA); George Town, Ross (TAS); Coomalie, Litchfield (NT)

Rem 1 Remote centres 25,000 – 99,999 Broome, Kalgoorlie/Boulder, Alice Springs

Rem 2 Other remote centres 10,000 – 24,999 Bourke, Orbost, Quilpie, Coober Pedy, Shark Bay, King Island, Gove

Source: Rural, Remote and Metropolitan Area (RRMA) classification developed by the Commonwealth Departments of Primary Industries and Energy and Health and Family Services (DPIE & DHFS 1994).).


142

APPENDIX 9

Standards for Supervision

143

Leanne.Hook

Typewritten Text

Leanne.Hook

Typewritten Text


Leanne.Hook

Typewritten Text

Leanne.Hook

Typewritten Text

Leanne.Hook

Typewritten Text

Leanne.Hook

Typewritten Text


144

2

Table of contents

Table of contents 2

The SET program and supervision 3

Standards for supervisors 3

Supervisors as teachers and assessors 3

Supervisor responsibilities aligned to RACS competencies 4

Supervisor role 5

Supervisor attributes 5

Supervisor support 5

Principal responsibilities of a surgical supervisor 6

RACS resources for supervisors 8

Contributors 9

References 10


145

3

The SET program and supervision

The Royal Australasian College of Surgeons (RACS), is responsible for the delivery of the RACS Surgical Education and Training (SET) program, through its Specialty Training Boards (STBs) and in collaboration with Specialty Society partners. The STBs are responsible for the selection, assessment, supervision and management of surgical trainees in accredited hospital-based training posts, under the direction of appointed supervisors.

The SET program relies on the significant pro bono commitment of Fellows who undertake the supervisor role. Supervisors, who are RACS Fellows in the relevant specialty, offer their time and expertise to train the independent surgical consultants of the future and to ensure that the Australian and New Zealand communities receive healthcare at continuing world class standards.

RACS recognises the multiple responsibilities of surgeons as they provide patient care and manage clinical risks, in addition to delivering comprehensive training and supervision. Sharing knowledge and expertise with the next generation of surgeons is one of the most significant contributions an individual Fellow can make to the community and to the collegiality of RACS.

Supervisor, as a nomenclature, means the designated supervisor for the specialty for an accredited training post at the hospital. Other terms are sometimes used by STBs and are defined in individual STB training regulations.

Standards for supervisors

To assist supervisors in their roles in educating and assessing trainees for the relevant STBs, RACS has developed a set of standards. The standards outline the attributes, roles and responsibilities and effective teaching methods for supervisors, who model the integration of the RACS competencies into daily practice. Defined standards of educational practice for supervisors are necessary to improve and maintain high-quality surgical education and training.

The standards for supervisors are consistent with the accreditation standards of the Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ) that govern specialist medical colleges.

The RACS Building Respect, Improving Patient Safety Action Plan(1) identifies the need for supervisors to be equipped with appropriate teaching, interpersonal and leadership skills in order to educate trainees. The standards provide a framework to clarify the expectations of the supervisory role and can be referenced as a guide to improve the quality of clinical teaching and learning(2).

The standards encompass the nine RACS competencies that are incorporated into the SET program. The ‘Becoming a Competent and Proficient Surgeon: Training Standards for the Nine RACS Competencies’(3) provides guidance for supervisors, trainers and trainees to stage training in each of the competencies.

Supervisors as teachers and assessors

Supervisors of training are key personnel in guiding and supporting trainees in their workplace learning and in the assessment of that learning. The workplace is the richest environment for trainees to gain the knowledge, skills and behaviours required for practising clinicians(4). Real life activities engage the trainee on a higher cognitive level and are the foundation of the SET program. Situated learning encourages the learning and consolidation of new skills, knowledge and behaviours. Interacting with role models and responding to feedback assists trainees to attain professional behaviours.

Work-based learning and assessment, as outlined in the RACS Work-based Assessment: A practical guide(5), facilitates the integration of multiple competencies. Relating the learning to different contexts encourages the trainee to review and reconnect their knowledge and skills. This strengthens long-term memory, information retention, retrieval and the transfer of learning.(6)


146

http://www.surgeons.org/media/22260415/RACS-Action-Plan_Bullying-Harassment_F-Low-Res_FINAL.pdf

http://www.surgeons.org/media/21706014/mnl_2012-02-24_training_standards_final_formatted.pdf


http://www.surgeons.org/media/20786937/bkt_tripartite_wba__march_7__2_.pdf


4

Supervisor responsibilities aligned to RACS competencies

The responsibilities at the core of clinical supervision and trainee support can be mapped to the RACS competencies.

Principal Responsibility

Co

lla

bo

rati

on

an

d T

eam

wo

rk

Co

mm

un

ica

tio

n

Hea

lth

Ad

vo

ca

cy

Ju

dg

em

en

t-C

lin

ica

l d

ec

isio

n M

ak

ing

Ma

na

ge

men

t &

Le

ad

ers

hip

Me

dic

al

Ex

pe

rtis

e

Pro

fes

sio

na

lism

& E

thic

s

Sc

ho

lars

hip

& T

ea

ch

ing

Te

ch

nic

al

Exp

ert

ise

1. Demonstrates all RACS competencies with patients and all work healthcare workers

X X X X X X X X X

2. Undertakes trainee orientation X X X X X

3. Ensures trainees receive appropriate training, observation, assessment and feedback

X X X

4. Leads in-training assessment X X X X X X X

5. Guides trainees’ personal and professional development

X X X X X X

6. Liaises with the training board and/or regional subcommittee regarding their trainees’ performance and wellbeing

X X X X X

7. Provides feedback at scheduled performance reviews and when underperformance has been identified

X X X X X X

8. Coordinates, in liaison with the boards, the remediation process for a trainee with identified underperformance in rotations and/or assessment tasks, including the early and Fellowship examinations

X X X X X X X


147

5

Supervisor role

Supervisors are crucial to meeting the community’s need for safe and effective clinical care. Supervisors ensure safe medical practice while facilitating the learning of future surgeons.

The aim of supervision is to facilitate trainees to become competent surgeons who provide consistently safe and effective surgical care of the highest standard to the Australian and New Zealand communities.

Effective supervision enables trainees to develop their practice safely and in supportive environments that expedite the acquisition of knowledge, skills and professionalism. Supervision promotes a culture of continuous learning and professional development(7).

The RACS Surgical Supervisors(8) policy, in conjunction with the relevant specialty training program Training Regulations, details the full role and responsibilities of supervisors.

Supervisor attributes

The attributes of an effective supervisor include:

Competent practitioner

Reflective and emotionally intelligent

Motivated to develop educational practice

Consistently models high standards of professional behaviour

Well organised

Develops rapport with trainees

Manages conflicts of interests

Available and responsive

Communicates and collaborates effectively

Enthusiastic educator

Supervisor support

RACS and the STBs support supervisors by ensuring that supervisors develop the knowledge, skills and behaviours necessary for the role. This is achieved by ensuring that supervisors:

are appropriately orientated and inducted to their role and responsibilities

are informed of and are able to access relevant professional development activities; and

have opportunities for feedback on their performance and opportunities to further develop their supervisory skills


148

http://www.surgeons.org/media/21856014/2016-10-14_pol_eta-set-013_surgical_supervisors.pdf

6

Principal responsibilities of a surgical supervisor

Surgical supervisors, irrespective of specialty, will perform tasks aligned to eight principal responsibilities that are the core of clinical supervision and trainee support. The following table lists those responsibilities and related tasks that are reflective of an effective supervisor. Each responsibility can also be mapped to the RACS competencies.

Principal Responsibility Related Tasks

1. Demonstrates all RACS competencies with patients and all healthcare workers

Role models professional behaviour at all times

Ensures patient safety

Leads positive cultural change

Ensures compliance with training accreditation standards

2. Undertakes trainee orientation Conducts or coordinates post/workplace induction (e.g. systems, protocols, OHS, HR)

In conjunction with the trainee, develops learning goals and plans aligned to curriculum and trainee’s level of performance

Identifies and undertakes learning opportunities

Empowers trainees to undertake self-directed learning

3. Ensures trainees receive appropriate training, observation, assessment and feedback

Ensures that training and assessments are aligned to curricula and trainees’ knowledge and skills

Liaises with trainers regarding trainee learning goals and plans

Directs trainees to learning opportunities and resources

Observes trainees and provides regular, specific feedback to guide trainee performance

4. Leads in-training assessment Liaises with trainers to provide comprehensive mid-term formative assessments and end-of-term summative assessments.

Modifies trainees’ learning goals and plans where indicated.

Complies with STB and RACS assessment and reporting requirements

5. Guides trainees’ personal and professional development

Is available for and provides confidential advice on trainees’ concerns including career advice, wellbeing

Encourages open communication with trainees

Encourages trainees to establish work-life balance, e.g. by providing advice regarding flexible training options, career trajectories and leave.

Facilitates trainees to reflect on decision-making and performance

Advocates (with Board and employers) for trainee education and career opportunities


149

7

Principal Responsibility Related Tasks

6. Liaises with the training board and/or regional subcommittee regarding their trainees’ performance and wellbeing

Informs board/regional committee regarding trainee performance

Advocates for trainee wellbeing

Alerts training board regarding trainee underperformance

Identifies trainee stress, fatigue and underperformance, and acts to address these

7. Provides feedback at scheduled perfromance reviews and when underperformance has been identified

Adopts effective methods for providing timely, constructive and respectful feedback to guide learning and performance

Identifies trainee underperformance and communicates this appropriately

Regularly documents examples of trainee performance

Highlights and reinforces satisfactory performance

8. Coordinates, in liaision with the boards, the remediation process for a trainee with identified underperformance in rotations and/or assessment tasks, including the early and Fellowship examinations

Helps trainee to identify areas for improvement

Works with trainee to clarify agreed standards of performance

Assists in developing specific strategies for supporting improvement in performance

Regularly monitors trainee performance and wellbeing

Complies with reporting requirements


150

8

RACS resources for supervisors

Publications

RACS Becoming a Competent and Proficient Surgeon: Training standards for the Nine RACS Competencies, outlines the nine competencies and describes the stages of progress from a pre-vocational doctor to a competent clinician(3).

RACS Surgical Competence and Performance: A guide to aid the assessment and development of surgeons. The framework provides a structured conceptual map of the learning outcomes of the SET program(s): description s of surgical performance as behaviours(9).

RACS Work-based Assessment: A practical guide for building an assessment system around work(5).

Courses

Foundation Skills for Surgical Educators – mandatory

Operate with Respect - mandatory

Surgical Teacher’s Course - desirable

Supervisors and Trainers for Surgical Education and Training (SATSET) (or module)

Keeping Trainees on Track (KTOT) (or module)

Clinical Decision Making

Critical Literature Evaluation and Research (CLEAR)

Forums

Academy of Surgical Educators Forum

Academy Educator Studio Sessions - webinar

eLearning modules

Let’s Operate with Respect - mandatory

Keeping Trainees on Track (KTOT)

Supervisors and Trainers for Surgical Education and Training (SATSET)

Trainees in Difficulty

Standards of Performance

Goal Setting

Self-Assessment

RACS co-badged programs with the University of Melbourne

Graduate Certificate in Surgical Education

Graduate Diploma in Surgical Education

Masters in Surgical Education


151



http://www.surgeons.org/media/18955288/surgical_competence_and_performance_guide__2011_.pdf

http://www.surgeons.org/media/18955288/surgical_competence_and_performance_guide__2011_.pdf



9

Contributors

Mr John Batten, PRACS - President

Mr Tony Sparnon, FRACS - Censor in Chief

Mr Nigel Willis, FRACS NZ - Censor

Mr Adrian Antony, FRACS - Chair Board of Surgical Education and Training

A/Prof Kerin Fielding, FRACS - Deputy Chair Board of Surgical Education and Training

A/Prof Phil Carson, FRACS - Chair, Court of Examiners

Mr Robert Tam, FRACS - Chair, Board of Cardiothoracic Surgery

Dr Kellee Slater , FRACS - Chair, Board in General Surgery

Dr Mark Davies, FRACS - Chair, Board of Neurosurgery

Mr Omar Khorshid FRACS - Chair, AOA Federal Training Committee

Mr Tim Gregg, FRACS - Chair, New Zealand Board of Orthopaedic Surgery

Dr Niell Boustred, FRACS - Chair, Board of Otolaryngology Head and Neck Surgery

A/Prof Jonathan Karpelowsky, FRACS - Chair, Board of Paediatric Surgery

Mr David Morgan, FRACS - Chair, Australian Board of Plastic and Reconstructive Surgery

Miss Sarah Hulme, FRACS - Chair, New Zealand Board of Plastic and Reconstructive Surgery

Mr Melvyn Kuan, FRACS - Chair, Board of Urology

Mr Tim Wagner, FRACS - Chair, Board of Vascular Surgery

Mr Richard Wong She, FRACS - Chair, Surgical Science and Clinical Examination Committee

Prof Jonathan Serpell, FRACS - Chair, Prevocational & Skills Education Committee

Dr Philip Chia - RACSTA Representative

Prof Robert O’Brien - External Member

Mr Simon Bann, FRACS - NZ Subcommittee Chair, Board in General Surgery

Dr Rebecca Garland, FRACS - NZ Subcommittee Chair, Board of Otolaryngology Head and Neck Surgery

Dr Stuart Philip, FRACS - Incoming Chair, Board of Urology

A/Prof Stephen Tobin, FRACS - Dean of Education

Mr Glenn Petrusch - Director Education and Training Administration

Ms Zaita Oldfield - Manager Education Development and Rearch

Ms Sally Drummond - Learning and Development Officer


152

10

References

1. Australasian College of Surgeons. Building Respect , Improving Patient Safety Action Plan [Internet]. 2015. Available from: http://www.surgeons.org/media/22260415/RACS-Action-Plan_Bullying-Harassment_F-Low-Res_FINAL.pdf

2. Standards Australia. Standards Development [Internet]. 2017. Available from: http://www.standards.org.au/StandardsDevelopment/What_is_a_Standard/Pages/default.aspx

3. Australasian College of Surgeons. Becoming a Competent and Proficient Surgeon : Training Standards for the Nine RACS Competencies [Internet]. Melbourne; 2012. Available from: http://www.surgeons.org/media/18726523/mnl_2012-02-24_training_standards_final_1.pdf

4. Health Education and Training Institute. The Learning Guide: A handbook for allied health professionals facilitating learning in the workplace [Internet]. Sydney; 2012. Available from: http://www.heti.nsw.gov.au/Global/HETI-Resources/allied-health/allied-health-learning-guide.pdf

5. Tri-Partite Alliance Royal College of Physicians and Surgeons of Canada Royal Australasian College of Physicians and the Royal Australasian College of Surgeons. Work-based Assessment: A practical guide. [Internet]. 2014 [cited 2017 Jan 23]. Available from: http://www.surgeons.org/media/20786937/bkt_tripartite_wba__march_7__2_.pdf

6. Gooding HC, Mann K, Armstrong E. Twelve tips for applying the science of learning to health professions education. Med Teach [Internet]. 2016;on-line(0):1–6. Available from: https://www.tandfonline.com/doi/full/10.1080/0142159X.2016.1231913

7. Health Education and Training Institute. The Superguide: A handbook for supervising allied health professionals [Internet]. Sydney; 2011. Available from: http://www.heti.nsw.gov.au/Global/HETI-Resources/allied-health/Superguide-May-2012.pdf

8. Royal Australasian College of Surgeons. Surgical Supervisor Policy [Internet]. Available from: http://www.surgeons.org/media/21856014/2016-10-14_pol_eta-set-013_surgical_supervisors.pdf

9. Australasian College of Surgeons, Royal Australasian College of Surgeons. Surgical Competence and Performance: A guide to aid the assessment and development of surgeons. [Internet]. 2011 [cited 2017 Jan 23]. Available from: http://www.surgeons.org/media/18955288/surgical_competence_and_performance_guide__2011_.pdf


153

154

APPENDIX 10

Specialty responses to AMC recommendations and conditions

Information provided by specialty training boards, pertaining to individual specialty training programs, is

presented verbatim in this appendix.

155


Specialty responses - Standard 1: The context of training and education



Areas covered by this standard: governance of the college; program management; reconsideration, review

and appeals processes; educational expertise and exchange; educational resources; interaction with the

health sector; continuous renewal.

Summary of college performance against Standard 1

In 2017, this set of standards was found to be Substantially Met.


Standard 1 Recommendation for improvement

AA Broaden the definition of conflict of interest to include reflection on an individual’s

demography, committee roles, public positions or research interests that may bias

decision making in areas such as selection or specialist international medical graduate

assessment. (Standard 1.1.6)

Significant developments per specialty


Conflict of interest, either perceived or pecuniary, is declared at every Board meeting. Researchers during

the training are required to declare any conflict of interest which must be approved by the Board and relevant

research ethics committees.

Declaration of conflict of interest policy is already in place for the IMG interview. The interview comprises a

specialty representative, a representative of the Board of SET and a jurisdictional representative.

There are already policies in place for SET trainees’ selection and interviewers are asked to declare any

conflict of interest prior to the interview. A formal process will be implemented prior to selecting interviewers

in 2019. (for discussion at the June board meeting) The selection process is transparent in scoring each

section of the curriculum vitae, work experience, academic records, research, interview performance and

standardisation of the referee reports. The scoring is done by two board members and scores must be

equally matched. Unmatched scores are referred to the Chair for further marking.

There is also a diversity and inclusion plan with no discrimination policy.

General Surgery – Australia

Conflicts of interests are declared at the beginning of each Committee of Board meeting. For selection,

interviewers must declare a conflict if they have run a commercial-based interview preparation course.

General Surgery – New Zealand

Nothing specific for NZ – we believe our current reminder is sufficient.

Orthopaedic Surgery – Australia

The AOA Board has given consideration to the need to be aware of three types of conflict of interest: actual

conflict, perceived conflict and potential conflict. It is acknowledged that conflicts exist however; it is how

they are managed that is most important.

156



Members of the Board sign a Board Protocol statement and members of AOA major committees are required

to sign a Committee Duties and Liabilities Protocol which covers conflicts of interest. At the commencement

of each meeting, the opportunity to declare any conflicts is provided.

The AOA Code of Conduct also covers conflicts of interest.

The AOA Position Statement on Medical Industry, Addendum 2 defines conflict of interest as follows:

…a conflict of interest occurs when a member or an immediate family member has, directly

or indirectly, a financial interest or positional interest or other relationship with industry that

could be perceived as influencing the member’s obligation to act in the best interest of the

patient.

A ‘financial interest’, ‘financial arrangement’, ‘financial inducement’ or ‘financial support’ includes, but is not

limited to:

Compensation from employment;

Compensation from patient referral pattern;

Paid consultancy, advisory board service, etc.;

Share ownership or options;

Intellectual property rights (patents, copyrights, trademarks, licensing agreements, and royalty

arrangements);

Paid expert opinion;

Honoraria, speakers’ fees;

Gifts;

Travel; and

Meals and hospitality.

A ‘positional interest’ occurs when an orthopaedic surgeon or family member is an owner, officer, director,

trustee, editorial board member, consultant, or employee of a company with which the orthopaedic surgeon

has or is considering a transaction or arrangement.

As part of the selection interviewer appointment process, potential interviewers are asked to sign a

declaration with regard to conflicts of interest. During interviewer training, attention is drawn to the

appropriate process where a conflict may exist and potential sources of bias are discussed. Conflicted

interviewers are asked to step out for the duration of the interview.


The Board of Otolaryngology includes a broad-based Conflict of Interest statement at all meetings. All board

members must declare any conflict of interest at the commencement of any meeting, whether face-to-face,

via telephone or webinar.

Paediatric Surgery

The Board of Paediatric Surgery has introduced the RACS Aboriginal and Torres Strait Islander Surgical

Trainee Selection Initiative and an Academic Pathway into the Training Regulations.

The Paediatric Pathophysiology Examination is now a pre-requisite for Senior SET training and the Board

has developed a separate syllabus for the exam.

Plastic and Reconstructive Surgery – Australia

RACS Policy exists.

Concern exists that smaller specialties like plastic surgery may become ineffective if the number of available

and suitably skilled educators or governance professionals are restricted from participation on important

matters due to broad definitions of “Conflict of Interest”. The Board relies on RACS’ legal counsel’s advice

157



and existing frameworks such as the Natural Justice Position Paper when making decisions that affect

trainees and IMGs.

Plastic and Reconstructive Surgery – New Zealand

The New Zealand Board of Plastic and Reconstructive Surgery (NZBPRS) looks to RACS for guidance on

bias and conflicts of interest and how to mitigate this, as this issue has a unique feature with respect to the

Board. Supervisors of Training compose the majority of board members, so have the dual responsibility of

being a direct supervisor. This means most board members have selected, trained, handed over trainees to

other training units, and, in some situations, performance-managed trainees. Plastic and Reconstructive

Surgery in New Zealand is a small speciality with four training units in New Zealand and trainees rotate

through most, if not all, of these units. Conflict of interest is a standing agenda item and is also raised when

issues containing potential conflict are discussed.

Urology

No progress

Vascular Surgery

The Board of Vascular Surgery conducted a review of the program in 2015, and the revised regulations

included management of underperforming trainees; the role of the Board in rating of assessments; role of

supervisors; and review of required rotations of each trainee. The regulations are now reviewed annually and

in 2017 the Board introduced flexible (part-time) training regulations, and is currently developing a minimum

standard for selection in response to the introduction of RACS Aboriginal and Torres Strait Islander Surgical

Trainee Selection Initiative.

Activity aligned with conditions

Condition 1 Review the relationships between Council, the Education Board, the Board of Surgical Education and Training and the Specialty Training Boards to ensure that the governance structure enables all training programs to meet RACS policies and AMC standards. (Standard 1.2)

To be met by 2019

Progress reported by specialty


Currently, we have an elected Councillor as a co-opted member of the Cardiothoracic Training Board who

provides direct reporting from Council. The Chair of the Board also attends the three annual Board of

Surgical Education and Training meetings. These are usually held on the day before the Cardiothoracic

Board meeting. Important issues relevant to the Cardiothoracic training as well as RACS matters are

reported to the Board at each Board meeting. A standard agenda item is dedicated for these matters. It is

envisaged that the current organisational structure is maintained in the future to maintain direct

communication and policies implementation.

Neurosurgery

Feedback is being provided to RACS to amalgamate the Board of Surgical Education and Training and the

Education Board and refine the membership with the priority being the specialty training board chairs.


The Australian Orthopaedic Association (AOA) has provided feedback on its preferences for governance

arrangements for RACS boards via correspondence dated 27 March 2018.

158



Orthopaedic Surgery – New Zealand

The New Zealand Orthopaedic Association (NZOA) has made significant progress in this area. We have

completed a rigorous review of our governance structure and appeals process. Revised terms of reference

have been developed and approved by the NZOA Council.


The Board has a strong relationship with RACS Council. The RACS Vice President, Dr Catherine Ferguson,

is an Otolaryngology Head and Neck surgeon; Dr Ferguson made a presentation in this capacity to the

ASOHNS Annual Scientific meeting in March 2018. A/Prof Chris Perry OAM, Immediate Past President of

ASOHNS, is a specialty elected member of RACS Council and is a member of the OHNS Training Board.

Paediatric Surgery

The Board Chair, Paediatric Surgery Councillor and the President of the Australian and New Zealand

Association of Paediatric Surgeons (ANZAPS) met with the RACS President John Batten and RACS CEO

Mary Harney in February 2018, to discuss any concerns the Board and ANZAPS may have.

Concerns were raised about the current structure of the RACS complaints process. This was echoed at the

February 2018 BSET meeting by other specialty board chairs.

The Board and ANZAPS look forward to keeping the path of communication open.


Discussions commenced with follow up:

Senior Leader’s Forum presentation by the Australian Board of Plastic and Reconstructive Surgery

(ABPRS) Chair, November 2017.

Australian Society of Plastic Surgeons (ASPS) and RACS leadership meeting January 2018.

BSET February 2018 discussion


The NZPRS Board views this review to be a RACS led initiative. The Board Chair attends the Board of

Surgical Education and Training meetings and feeds back to the Board via a standing item on the Board

agenda. The Board has also been party to discussion with RACS via the Surgical Leaders’ Forum, October

2017 and the RACS leadership meeting February 2018.

Urology

No progress – RACS management initiative required.

Vascular Surgery

Members of the Australian and New Zealand Society for Vascular Surgery (ANZSVS) Executive (including

the Board Chairman) recently met with the RACS President John Batten, the RACS CEO Mary Harney, and

other executive staff at the College. The Board Chair raised concerns about the current structure of the

RACS complaints process and the ability of the College to deal with discrimination, bullying, and harassment

complaints in contrast to the Board’s process when a complaint has been received. This feeling was echoed

at the most recent BSET meeting by other specialty Board Chairs. The Board is currently writing Vascular

Surgery-specific hospital accreditation regulations that detail how the Board will manage complains of

discrimination, bullying, and harassment.

During the meeting with the College, the Board Chair also expressed concern that the workload among

supervisors is increasing and while the hospitals have been very receptive to the Operating with Respect

159



conversation, there needs to be a unified message from the College that the employers need to resource

supervisors effectively. This issue was also discussed at the most recent BSET meeting.

The President of the ANZSVS highlighted the main issue from the Society’s point of view is the Partnering

Agreement and how it relates to professional development. The President and CEO were made aware of

how scope of practice is defined by the Society, and the Society’s aim to have this adopted by the College

via the Australasian Vascular Audit by introducing it into a Vascular Surgery specific CPD program facilitated

by RACS.


Condition 2 RACS must develop and implement a stronger process for ongoing evaluation as to whether each of these programs remain consistent with the education and training policies of the College. (Standard 1.2)

To be met by 2020



The Chair plays a significant role in the BSET meeting and in co-ordinating important policies and issues

recommended by AMC, College Council, BSET and the Cardiothoracic Training Board. There is direct

communication between the Chair of BSET and the Cardiothoracic Training Board. Important issues with

regard to training are then disseminated to all board members.

Neurosurgery

Nothing to report

Orthopaedic Surgery - Australia

AOA considers this may be achieved through the Service Agreement


NZOA has reviewed the new curriculum and selection process to ensure they map to the RACS

competencies.


Otolaryngology Head and Neck Surgery participated in the SET Selection Workshop, held in April 2018.

Paediatric Surgery

No developments yet.


RACS responsibility.


The New Zealand Board of Plastic and Reconstructive Surgery (NZBPRS) took part in the RACS SET

selection workshop on 14 April, 2018 to learn from and share selection information collaboratively and to

improve our processes.

160



Urology

No progress – RACS initiative required.

Vascular Surgery

The Board will work with the College to

introduce training processes in professional behaviour.

embed professional standards in education and training with regard to cost effectiveness, safety, and

quality.

assess perioperative management in the SET program.

introduce cultural competence training to the SET program.

The Board is currently working on introducing these concepts into the annual Vascular Surgery Trainee Skills

Course.


Condition 3 Develop a common policy that makes it explicit that all Specialty Training Boards must develop and implement defined reconsideration, review and appeals policies which clearly outline the processes for each of the three phases. (Standard 1.3)

To be met by 2018



There are already in place common policies. There is a process for reconsideration, appeal and other

ongoing review policies. Any major issues and decisions regarding a trainee’s performance are evaluated

and discussed at the Board meeting. This allows natural justice and an appropriate appeals process is

offered to the trainee. Implementation and monitoring of any new policies are reviewed by the Cardiothoracic

Board and at EB/BSET.

General Surgery

General Surgery already has a review and grievance policy for trainees and also for hospital inspections.

Neurosurgery

The Board of Neurosurgery has a Regulation, which sets out the mechanism for reconsideration, review and

appeal by trainees adversely affected by a decision relating to their training program. This has recently been

refined. The process consists of three clearly defined phases as follows:

reconsideration of the original decision (Reconsideration);

review of the original decision and the Reconsideration decision (Review); and

a formal appeals process (Appeal).

Trainees are engaged in the process and it is working very effectively.


AOA has a well-established Reconsideration, Review and Appeal Policy. A copy of this has been provided to

RACS following receipt of the AMC Report. The Policy is currently under review with a view to refining the

existing process.

161




The process has been defined, and will be included into NZOA regulations for 2019.


The Otolaryngology Head and Neck Surgery Training Regulations adhere to the RACS Reconsideration,

Review and Appeal policy.

Paediatric Surgery

Once the policy has been developed by RACS, it will be incorporated into the Paediatric Surgery Training

Regulations.

Plastic and Reconstructive Surgery - Australia

A draft Training Regulation has been prepared (January 2018) and will be considered by the Australian

Board of Plastic and Reconstructive Surgery, pending decisions from the June 2018 BSET meeting. In July

2018, the ABPRS approved its Training Regulation Reconsideration, Review Appeal


The NZBPRS amended the NZ PRS Training Regulations in November 2017, which included clarification of

the review process for consideration of dismissal from the training program. The 2019 Training Regulations

will be updated to provide clarity on the process for reconsideration and review of decisions. The NZBPRS

adopts the RACS appeals process.

Urology

No progress. Policy development is required by RACS, rather than the specialty training boards. Once the

RACS policy has been defined and approved, the Board of Urology will develop specific reconsideration and

review processes which will be incorporated into the SET Urology Training Regulations.

Vascular Surgery

RACS to provide further information.

162




Condition 4 Provide evidence of effective implementation, monitoring and evaluation of the:

(i) Reconciliation Action Plan

(ii) Building Respect, Improving Patient Safety (BRIPS) Action Plan

(iii) Diversity and Inclusion Plan. (Standard 1.6 and 1.7)

To be met by 2021



(i) and (ii) above, all Fellows are FSSE and OWR compliant. All trainees are OWR compliant

(iii) above, the Cardiothoracic Board has inclusion policies for Aboriginal and Torres Strait Islanders and

Māori trainees. The Flexible Training policy is already in place with the MOU signed with 14 teaching

hospitals across the country.


The Board in General Surgery (BiGS) has attempted to identify all trainers in Australia and has provided this

information to RACS.

A process of ensuring trainers are kept up to date is being implemented to ensure BiGS knows when to

follow up compliance. Compliance for supervisors and trainers has also been included in hospital

accreditation applications and inspection reports.

Neurosurgery

The Board has appointed an external representative who commenced in March 2018. The Board has been

very active in promoting the compulsory training and has a high compliance rate. The Board has also

modified its Training Post Regulations to reflect the new supervisor requirements.


The AOA Board approved the RACS Diversity Plan 2018-2023 at a board meeting held on 21 April 2018


We have met the requirements of Condition 4 (ii). Progress on 4(i) and 4(iii) is being made.


The Otolaryngology Head and Neck Surgery Training Board has considered the action plans in formulating

the new curriculum and in development of regulations.

Paediatric Surgery

RACS to provide further information.


Planned to commence consideration by the Board in early 2019

163




BRIPS: The NZBPRS reviews data provided by RACS on progress of completion of the mandatory courses

as part of Building Respect, Improving Patient Safety (BRIPS) reporting at their Board meetings. Supervisors

actively encourage trainers in their units to complete the mandatory courses.

Diversity and Inclusion Plan: The NZBPRS has initiated communication with NZAPS to implement an annual

scholarship for medical students of Māori and Pacific Island descent to attend the NZAPS Annual scientific

meeting (ASM). The NZBPRS is also communicating with hospital training units with regard to how they

could implement flexible training within their units.

Urology

No progress

Vascular Surgery

RACS to provide further information. The Board of Vascular Surgery is developing regulations in relation to

newly introduced RACS policy, and is actively following up Vascular Surgery membership to ensure

adherence to the BRIPS Action Plan.

164

Standard 2: The outcomes of Specialist training and education



Areas covered by this standard: educational purpose of the educational provider; and, program and graduate

outcomes




Standard 2 Recommendations for improvement

BB Benchmark the graduate outcomes of each of the surgical training programs

internationally. (Standards 2.2 and 2.3)

CC Improve the uniformity of presentation of training program requirements and graduate outcomes for each of the surgical specialties (particularly on the website), taking into account feedback from trainees, supervisors and key stakeholder groups. (Standards 2.2 and 2.3)

DD In conjunction with the Specialty Training Boards, review and report on the reasons for the pervasiveness of post- fellowship training and any potential impact on the appropriateness of the Surgical Education and Training (SET) program. (Standard 2.3)



BB and CC: Standard 2.2, 2.3 - No significant developments

DD: There is significant development in devices technology in cardiology and cardiac surgery. Most

new technology driven procedures at present are regarded as a post-Fellowship training both in

Australia and overseas. It is unlikely that the current SET training will provide trainees with

adequate exposure during their SET training.

The Board and the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) is

working closely with the Australian and New Zealand Cardiac Society (ANZCS) and both have developed a

multidisciplinary approach to manage this group of patients to get the best outcomes. This allows the

cardiologist and surgeon to work together as a cohesive team. Under the new guidelines developed by the

two societies and approved by the Federal Health Department, there will be dual operators allowing a

cardiac surgeon to perform percutaneous valve implant as the primary surgeon.


CC General Surgery will be moving to a five-year program and as part of the redevelopment

graduate outcomes will be identified more clearly through EPAs and PBAs.

DD Fellowship posts and their impact on training are reviewed during quinquennial inspections.

Hospitals with fellows are required to have a delegation of responsibilities to ensure trainees are

obtaining the appropriate and required training.


Nothing specific

165




BB The AOA 21 Training Program has been benchmarked globally and is considered best

educational practice.

DD The AOA 21 Training Program produces general orthopaedic surgeons. The curriculum

outlines the required competencies across the breadth of the specialty. Surgical skills are

categorised into three levels. On their first day of independent practice, all trainees graduating

from the AOA 21 training program will be able to competently perform all procedures listed in

level one. They will have been provided with the opportunity to observe, assist with or perform

under supervision those procedures listed in level two. In addition, they will be able to discuss

how procedures in level three would be performed.

Many trainees will have a special interest and choose to sub-specialise. This is achieved through completion

of Fellowship roles. As a feature of the AOA 21 Training Program, trainees will have to option to apply to

complete a Fellowship as part of their Transition to Practice stage of training.

In addition, it is recognised that it is valuable for surgeons to gain additional experience in an overseas

context and that this may broaden and deepen the training experience.


We are developing a shared competency-based curriculum with the AOA


BB The Board of Otolaryngology Head and Neck Surgery is currently finalising an update to the

SET OHNS curriculum. The new curriculum articulates the expected graduate outcomes of the

SET OHNS program.


BB In progress and is largely complete. Development has been through integration of Entrustable

Professional Activities (EPAs) and appropriate assessment tools into the articulated draft

curriculum (draft completed December 2017, internal stakeholders’ comments considered in

June, wider consultation due before end 2018). EPAs were drafted in March 2018 at a

workshop with Australian and NZ representatives. In September 2018, the draft EPAs and new

assessment tools will be considered with the view to finalising them.

CC No response.

DD Post-Fellowship education and training (PFET) programs enable sub-specialisation to

complement the breadth of knowledge, skills and attributes obtained during SET. Several post-

Fellowship educating and training programs exist already (hand surgery and craniomaxillofacial

surgery).


BB This will be a clear outcome of the finalised curriculum which is currently in the review process.

CC The finalised curriculum will be published and easily accessible to stakeholders.

DD Several subspecialties in PRS are appropriately entered by post-fellowship education and

training (PFET) programs e.g. hand surgery, craniofacial surgery. Specialist societies oversee

these with input from STBs and complement SET.

166



Urology

No significant developments – there is considerable work in progress which has been outlined in other

sections of this report.


Condition 5 Define how the College’s educational purpose connects to its community responsibilities. (Standard 2.1)

To be met by 2020



In September 2017, College Council and the Board of Cardiothoracic Surgery had appointed an external

Board member. It is expected that the external Board member will provide input regarding the community’s

expectation around surgical training.

Neurosurgery

RACS reporting on this.


The OHNS Training Board has a community representative who is a full board member and actively

participates in discussions, representing the community.

Paediatric Surgery

To be confirmed by RACS


RACS responsibility


No progress.

Urology

No progress

Vascular Surgery

To be confirmed by RACS

167




Condition 6 Broaden consultation with consumer, community, surgical and non-surgical medical, nursing and allied health stakeholders about the goals and objectives of surgical training, including a broad approach to external representation across the College. (Standard 2.1)

To be met by 2021



In addition to the above, the Board has a trainee representative who is considered as a full board member.

All trainees have direct communication with him/her and a full report is provided by them at each board

meeting.

In the course of hospital inspections for re accreditation or new facilities requesting accreditation for SET

training, surgical and non-surgical medical, nursing and allied health personnel are interviewed as a broader

consultation process.

There are no significant developments with broader non-surgical consultation with consumer, community,

and allied health stakeholders at present.

General Surgery

BiGS has appointed an external representative and jurisdictional representatives are always invited to

quinquennial inspections.

Neurosurgery

External representative commenced on the Board in March 2018.


AOA is in the process of recruiting an external representative to the Federal Training Committee (FTC). The

FTC already has jurisdictional and trainee representatives as full voting members.


We have expanded our Training Board to include a cultural and consumer adviser.


The OHNS Training Board has a community representative who is a full board member and actively

participates in discussions, representing the community.

Paediatric Surgery

To be confirmed by RACS. A community representative has been appointed to the Board of Paediatric

Surgery and is a full member of the Board. The Community Representative is involved not only in board

meetings, but various undertakings of the Board such as review of training regulations, and hospital

inspections. In addition to this the Board of Paediatric Surgery has undertaken consultation with consumer

groups regarding the perceptions of trainees, paediatric surgeons and the needs of patients (Bowel Group

Kids).

168




The Australian Board of Plastic and Reconstructive Surgery welcomed the appointment of Adjunct Professor

Claire Langdon onto the Board. Adjunct Professor Langdon is actively contributing to the governance work

of the Board.


The NZBPRS welcomed the appointment of Mrs Susan Lloyd, the RACS External Representative onto the

Board, and is actively engaging in recommendations made by Susan such as governance skills training for

board members.

Urology

An external representative is now a voting member of the Board of Urology. She is an active contributor at

board meetings and often provides a different perspective, which is very much appreciated and considered.

Vascular Surgery

To be confirmed by RACS. An external member has been appointed to the Board of Vascular Surgery and is

now involved not only in board meetings, but various undertakings of the Board such as review of

regulations, and hospital accreditation standards.


Condition7 Clearly and uniformly articulate program and graduate outcomes (for all specialties) which are publicly available, reflect community needs and which map to the nine RACS competencies. (Standard 2.2 and 2.3)

To be met by 2021



Freely available on the RACS website.

General Surgery

General Surgery will be moving to a five-year program and as part of the redevelopment graduate outcomes

will be identified more clearly through EPAs and PBAs.

Neurosurgery

Available on the website. No change to the previous report.


Outcomes for Orthopaedic Surgery have been defined within the AOA 21 curriculum


This is currently being done

169




See response to Recommendation BB, Standard 2, regarding curriculum. Outcomes are clearly defined in

the new curriculum

Paediatric Surgery

The Training Regulations are publicly available on the RACS website. RACS to map community needs.


Graduate outcomes have been articulated during the 2017 development of a refreshed draft curriculum

(completed December 2017). Stakeholder engagement commenced in February 2018 at the SET 1

conference followed by the SET 2-5 conference in March. SET conferences include Australian and New

Zealand SET trainees and selection of IMGs under clinical supervision.

Publically available documentation can be synthesised by RACS in 2019 following the Au and NZ Boards’

agreement to implement an approved curriculum. Uniformity and clarity of publicly available information can

be considered at that time.


The PRS curriculum has been rewritten and is shortly going to be reviewed by stakeholders prior to

implementation. A focus of the revision has been to make it clear to trainers and stakeholders what the

expectations of the training programme are. We will continue to be involved in this review in 2018.

Urology

The Education Subcommittee of the Board of Urology is currently undertaking a comprehensive review of the

Urology curriculum. Significant modifications will be made and the revised curriculum will more clearly define

the expectations and abilities (including technical skills) possessed by graduates of the SET Urology training

program.

Vascular Surgery

RACS to map community needs.

170




Areas covered by this standard: curriculum framework; curriculum content; continuum of training, education

and practice, and curriculum structure.





EE Develop explicit criteria to consider whether training periods of less than the standard six months can be approved, and ensure that prior learning, time and competencies acquired in non-accredited training are fairly evaluated as to whether they may count towards training. (Standard 3.1)

FF Make available to all trainees the learning modules under the Building Respect, Improving Patient Safety (BRIPS) program, once most or all College Fellows are trained. (Standard 3.2)



EE The Board has approved and supports competency based rather than time based training.

The Board also supports recognition of prior learning.

FF Standard 3.2 MET

Supervisors and trainers are mandated to complete the FSSE, “Operating with Respect” and SAT SET

training as part of the BRIPS program. All trainees are mandated to do “Operating with Respect“ online

modules as well as other compulsory courses as stipulated in the training regulations.


EE General Surgery regulations allow for recognition of prior learning for trainees who have been

on the training program previously. Various requirements must be met before this is awarded

however the requirements can be met within the first year of training. General Surgery is also

reviewing their flexible training options in regards to trainees who only complete 2-3 months of a

term.

Also see GS response to condition 13.


EE Nothing specific to NZ beyond BiGS proposals in this matter


EE The AOA 21 Training Program is competency-based and no longer requires accreditation of

training time. There are minimum and maximum time limits, however, these are simply

calculated by time spent in training and are not hinged on performance. The AOA 21 Flexible

Training Policy allows for recognition of prior learning

171



FF Trainees are actively encouraged to participate in AOA 21 workshops (including those deemed

comparable to the FSSE). Completion of the suite of workshops is a requirement of the

Transition to Practice stage of training.


We are developing a competency based curriculum with the AOA


The Board of Otolaryngology Head and Neck Surgery has recently updated the Training Regulations to

include provision for trainees to undertake flexible training in accordance with RACS policy. Trainees may

apply to undertake flexible training. OHNS allows periods of 3 months full-time or 6 months half-time to be

accredited.

The overall time required to complete training will be considered on an individual basis according to the

trainee’s circumstances, reflective of assessment of competence.

Paediatric Surgery

In May 2017, the Board of Paediatric Surgery wrote to the CEOs of each hospital accredited by Paediatric

Surgery to confirm that the Board is committed to supporting the trainees and eliminating any barriers to paid

parental leave. The Board suggested that the hospitals include the following clauses in all contracts for

Paediatric surgical trainees on the SET program:

For doctors employed as part of the RACS SET program in Paediatric Surgery:

Notwithstanding any provisions of the Award, a doctor who has completed 40 weeks of continuous service in

an accredited Paediatric Surgery SET training post in any state, shall have that service recognised for the

purposes of determining eligibility for paid parental leave.

In order to determine any parental entitlement, the Trainee’s employment status will be deemed permanent.

For the avoidance of doubt, this clause means that a trainee will be entitled to full parental entitlements

under this contract even where the Trainee’s period of employment ceases and would otherwise result in a

lesser entitlement

The response rate was low; however, one trainee at John Hunter Hospital was eventually granted an out of

award entitlement to paid parental leave, following this correspondence. The Board will continue to advocate

for the trainees and will raise flexible training at every hospital inspection.


EE Completed in July 2017 following 18 months of board level discussion and consultations. RACS

approved the changes to associated training regulations in November 2017. Explicit criteria are

available in the published Training Regulations ‘Assessment of Clinical Training’ and ‘Variations

to Training’, which is further explained in the 2018 edition of the Training Handbook.


No progress to date. Less than 6m accreditation of full time training periods is an Agenda item for

consideration at a future board meeting in May and August. Once the curriculum review is finalised it will be

appropriate to consider competency versus time based training.

Urology

There are already processes in place within the SET Program in Urology to recognise prior learning when

determining the level of entry into the training program. Additionally, the Training Regulations clearly

articulate the processes by which trainees can apply for and be granted recognition of prior learning for

172



experience acquired in non-accredited training. The Board has not yet considered the development of

explicit criteria for consideration of training periods less than six months.

The Board of Urology actively supports the participation of all trainees in the learning modules under the

BRIPS program once most or all College Fellows are trained. It is likely that these modules will be

incorporated into the curriculum as compulsory components of training.

The Board has already mandated the completion of the FSSE by all SET6 (final year) trainees and a

dedicated FSSE course for SET6 trainees was held in 2017 with another planned for 2018.

Vascular Surgery

The Board of Vascular Surgery has recently introduced flexible training into the program regulations and is

currently assessing whether a trainee undertaking a period of part-time training may be able to achieve

competency at the end of a term.


Condition 8 Enhance and align the non-technical competencies across all surgical specialties, including a consideration of the broader patient context. (Standard 3.2)

To be met by 2021



Incorporated in the SET training, non-technical competencies are assessed in the 360o feedback, DOPS,

and Supervisor’s Term Evaluation Form (TEF) assessment. The selection interview questions also have

quite extensive non-technical skill questions.

The Board is considering mandating the TIPS for SET training. The course concentrates on non-technical

competencies which is a well-established course offered by RACS.

Neurosurgery

RACS reporting on this


AOA considers the non-technical competencies to be the foundation for quality patient care. As such, they

are considered the foundation of the AOA 21 training program and are therefore referred to as ‘Foundation

Competencies’. This is graphically represented in the Curriculum Framework diagram.

173



The Introduction to Orthopaedics stage of training has a heavy focus on Foundation Competencies, which is

then built on throughout training. Trainees will spend a minimum of 12 months in the Introduction to

Orthopaedics stage. This phase of training is designed to facilitate the acquisition of basic orthopaedic

surgical skills and foundation competencies of an orthopaedic consultant, from which trainees can develop

further in the subsequent stages.


We are including non-technical competency based assessments in both selection and assessment of trainee

performance. The introduction of the Feedback App will also encourage better assessment


Non-technical competencies form a significant part of PBAs. Trainees on performance management plans

or learning action plans are required to undertake 360o evaluations. A board representative is scheduled to

attend a TIPS course in 2018.


Non-technical competencies form a significant part of PBAs. Trainees on performance management plans

or learning action plans are required to undertake 360o evaluations. A board representative is scheduled to

attend a TIPS course in 2018. OHNS NZ is including teaching on Non-Technical Skills for Surgeons

(NOTSS) in each annual training week.

Paediatric Surgery

No development yet.


Update March 2018: Since December 2017, the refreshed draft curriculum articulates and aligns non-

technical competencies for all topic areas within the curriculum. Associated assessment tools are planned for

development throughout 2018 and for consultation in late 2018 and implementation in 2019.


The NZBPRS and ABPRS have been working during 2016 and 2017 on a comprehensive curriculum review

including the non-technical competencies. This review will be continuing in 2018.

174



Urology

No progress – the Board believes this is something that RACS will need to facilitate.

Vascular Surgery

The Board is currently working to introduce the following concepts into the annual Vascular Trainee Skills

course.

Introduce training processes in professional behaviour.

Embed professional standards in education and training with regard to cost effectiveness, safety, and

quality.

Assessing perioperative management in the SET program.

Introducing cultural competence training to the SET program.

Last year the Board held a Foundation Skills for Surgical Educators during the Skills Course for SET 5

trainees and will continue to do this at the Skills Course.


Condition 9 As it applies to the specialty training program, expand the curricula to ensure trainees contribute to the effectiveness and efficiency of the healthcare system, through knowledge and understanding of the issues associated with the delivery of safe, high-quality and cost-effective health care across a range of settings within the Australian and/or New Zealand health systems. (Standard 3.2.6)

To be met by 2021



Standard 3.2.6

Neurosurgery

No developments


These competencies are covered in the AOA 21 Curriculum under Leadership and Organisational Skills and

Advocacy. Additional resources are to be developed for delivery through Bone School.


This is part of the curriculum review we are currently undertaking.


The curriculum review includes a process of understanding the ANZ healthcare systems.

Paediatric Surgery

No development yet.

175




Already implemented as per response to condition 8 above


No progress.

Urology

The current curriculum redevelopment project will incorporate and expand this aspect.

Vascular Surgery

Please see response to Condition 8 above.


Condition10 Document the management of peri-operative medical conditions and complications in the curricula of all specialty training programs. (Standards 3.2.3, 3.2.4 and 3.2.6)

To be met by 2021



This is done in the trainees’ three-monthly assessment in the form of log book, Mini-CEX and DOPs. The

performance of the trainee must be discussed in an open disclosure fashion and subsequently recorded in

the Term Evaluation Form. All these reports are scrutinised at board level. It is expected that the unit

conducts a peer review, M and M quarterly. These quality activities will be scrutinised by the Board during

the scheduled hospital inspection at 3–5 years for re-accreditation for SET.

There is no other significant development.

General Surgery

SEAM contains a peri-operative module that addresses this.

Neurosurgery

Already included in the curriculum.


The Surgical Expertise section of the AOA 21 Curriculum outlines competencies for pre-operative, intra-

operative and post-operative care. Non-operative care is also covered under Medical Expertise.


This is part of the curriculum review we are currently undertaking.


Peri-operative management of medical conditions is now included as a topic in the updated SET OHNS

curriculum.

176



Paediatric Surgery

Already implemented.


The updated curriculum (final draft December 2017) includes the management of peri-operative medical

conditions, post-operative complications, and the management of the peri-operative patient more generally.


Included in curriculum review

Urology

This will be explicitly included in the revised curriculum, which is under development.

Vascular Surgery


Condition 11 Include the specific health needs of Aboriginal and Torres Strait Islanders and/or Māori, along with cultural competence training, in the curricula of all specialty training programs. (Standard 3.2.10)

To be met by 2021



The Board has received approval for the inclusion of Aboriginal and Torres Strait Islanders into the SET

training program provided they reach the minimum standards.

There is currently no cultural competence training in place.

Neurosurgery

Nothing to report.


Competencies around cultural competence are included in the AOA 21 Curriculum under Advocacy. AOA is

currently reviewing the available cultural competence learning opportunities available. Discussions with the

Australian Indigenous Doctors’ Association (AIDA) have been initiated.


We are aware of this condition and acknowledge it is to be done.


The new SET OHNS curriculum includes the module: Aboriginal, Torres Strait Islander and Māori Health.

Paediatric Surgery

Need further information/guidance from RACS.

177




Completed December 2017: Section 3 (“Essential Surgical Competencies”, a.k.a. non-technical

competencies) of the draft curriculum (December 2017) include within the health advocacy section the

requirement to improve the delivery of care to Indigenous populations via Aboriginal and Māori health care

workers and support services.


The NZBPRS has encouraged, assisted and supported NZ PRS trainees to incorporate cultural awareness

and competency into their annual NZ training weekend program. In 2018 the planned program includes Te

Reo pronunciation (e.g. names) and the impact of surgical procedures common in PRS on cultural identity

(e.g. amputation of a finger, mastectomy, burns, cleft lip and palate).

Urology

The RACS Indigenous modules have already been incorporated into the Urology training program. Further

expansion will occur during the process of curriculum development.

Vascular Surgery

RACS broader guidelines will be required to meet this condition.


Condition 12 Clearly and uniformly articulate program and graduate outcomes (for all specialties) which are publicly available, reflect community needs and which map to the nine RACS competencies. (Standard 2.2 and 2.3)

To be met by 2021



The competency-based, recognition of prior learning, and flexible training policies are in place.

General Surgery

The Board has approved a move to competency-based training which includes EPAs and PBAs together

with an element of time. A detailed outline will be presented to RACS in June 2018.

Neurosurgery

Nothing to report.


AOA has adopted a modular entrustable professional activities (EPA) approach to progression through

training. While the AOA 21 training program no longer considers accredited time, the stages of training have

minimum and maximum completion timeframes.


We are working with the AOA to agree this.

178




The OHNS new curriculum identifies competence as: the ability to successfully meet complex demands

through the integration and application of learned facts, skills and affective qualities needed to serve the

patient, the community and the profession.

Whilst described separately, each of the nine RACS competencies is regarded as integrated – inter-

dependent and equally important.

A competency-based curriculum is developed around stated objectives that can be observed and measured.

It is characterised by:

Standardization of learning outcomes

Individualization of the learning process

Integration of formal knowledge and clinical experience

Learning is measured according to how well the learner performs in relation to competencies and

standards

Assessment is therefore criterion-referenced rather than in relation to other learners

The OHNS curriculum, implemented in 2018, delivers training in three stages: Novice, Intermediate and

Competent. Behavioural markers describe standards of performance in each stage, assessed through a

comprehensive program of work-based assessments: Mini-Clinical Evaluation Exercises (MiniCEX), Direct

Observation of Procedural Skills (DOPS), Procedural Based Assessment (PBAs), Case-Based Discussions

(CBDs), Mid-Term Assessments (MTAs) and End of Term Assessments (EOTAs).

Paediatric Surgery

RACS to confirm.


The refreshed Plastic Surgery curriculum (final draft December 2017) has introduced milestones for trainees

and trainers to monitor progress through the training program, as well as articulating the level of competence

to be achieved for each aspect of the training program. This will be paired with new assessment tools to

allow for programmatic assessment throughout training.


This has been incorporated in the curriculum review project undertaken in conjunction with the ABPRS

during 2016–2018 with the aim of implementation in 2019.

Urology

Assessment process under the curriculum in development will be based on a stricter determination of

procedural competence, proposed at this early stage to utilise Ottowa scales as the basis for assessment of

competence, with proficiency to be assessed by multiple assessors on several occasions before the trainee

is determined as competent. Exact numbers of observed cases to achieve competence are yet to be defined.

Vascular Surgery

In the Vascular Surgery curriculum, work-based assessments are based on seven competencies.

Performance standards are identified for each competency at each SET level.

179




Condition 13 RACS has a policy that is applicable to all specialty training programs to remove the overt and hidden barriers to flexible forms of training. RACS must build on the existing policy and processes, and liaise with hospitals to implement flexible training. (Standard 3.4.3)

To be met by 2018



A Flexible Training policy in terms of parental leave, interruption and deferment of training is already in place

and the Board will fully support and approve all applicants. The MOU on flexible training with the 14 teaching

hospitals is currently in place.

General Surgery

The Board has submitted regulations that assist in recognising when trainees only partially complete a

rotation due to illness, parental or carers’ leave. This is in an attempt to recognise the training undertaken

and to determine if it can be accredited towards the requirements. General Surgery has included a question

on flexible training in the Hospital Accreditation Standards and Inspection Reports.

Neurosurgery

The Board has identified criteria for flexible training post accreditation and is in the process of contacting all

accredited training units to see if any have posts, which would satisfy the requirements for accreditation.

The main barrier to flexible training is the availability of posts.


AOA has a Flexible Training Policy. This is supported by requirements in the newly developed Accreditation

Standards (to be rolled out in 2019) for training sites with 3 or more posts to make a part-time position

available.

Given the competency-based progression structure of the AOA 21 training program, training part-time does

not necessarily require an extension of training time provided competence is demonstrated.

AOA is actively working to increase diversity within the training program. Through our Diversity Strategy,

AOA is working towards identifying and removing barriers to training for female junior doctors.

The Board approved Diversity Strategy 2018–2023 at its meeting on 21 April 2018.


NZOA fully supports this and is currently liaising with hospitals on this.

NZOA has recently listed those DHBs that can accommodate flexible training onto the NZOA website, this

list is not an exhaustive list and will be added to as NZOA receives feedback.


The OHNS training board contacted regional training chairs regarding opportunities for flexible training and

to identify potential posts that could be considered for flexible training. In 2017, three trainees requested and

were granted part-time training positions. In 2018, all Victorian trainees were offered flexible training and all

declined. NZ OHNS has an expectation that all posts have flexible options and this has been organised in a

number of centres already. It is now part of the accreditation of existing and new posts.

180



Paediatric Surgery

Once the policy has been developed by RACS, it will be incorporated into the Paediatric Surgery Training

Regulations.

RACS wrote to all hospitals in November 2017 to determine which hospitals can accommodate flexible

training. Trainees will be notified of the hospitals that advised they can accommodate flexible training,

particularly for future allocations. The Board agreed to write to each hospital with more than two SET posts

to advise that if a centre has more than two SET posts, if feasible the centre must have a flexible training

post.

The Board of Paediatric Surgery agreed that to help ensure that trainees are not disadvantaged financially;

the Board agreed to allocate a trainee to a SET post for the entire year, even if they are aware the trainee

may not be in that post for the entire year due to parental leave. Only if the trainee will be interrupted for the

whole year, the Board will not allocate them to a SET post.


RACS to confirm policy. The Australian Board of Plastic and Reconstructive Surgery has already

implemented a broad and enabling set of Training Regulations to accommodate flexible training requests.

The Australian Society of Plastic and Reconstructive Surgery has surveyed all accredited hospitals on their

ability to cope with requests for flexible training. As is already clear from employment law, institutions should

already allow for flexible employment opportunities.


The NZ PRS Training Regulations specify conditions under which flexible training can occur and will be

reviewed at the May and August 2018 board meetings. The Board is also engaging in communication with

training units as to how the hospitals will be able to provide flexible training and assist in removing perceived

barriers. This remains an active agenda item in 2018 for further review. Two trainees have applied for flexible

training for 2019.

Urology

Whilst RACS is to develop the overarching policy, the Board of Urology is in the process of identifying

suitable positions and establishing flexible training posts, with a trainee likely to commence flexible training in

2019. To date, the Board has received favourable responses from a number of hospitals across Australia.

Vascular Surgery

RACS broader guidelines will be required to meet this standard

181





In 2017, this set of standards was found to be Met.


Recommendation for improvement

GG Consider options to mitigate the lack of training in some parts of Australia and New Zealand, such as in outpatient settings, endoscopy and aesthetic surgery. (Standard 4.2.1)



Not relevant


GG Outpatients is an issue in NSW however, several hospitals have trainees seeing new patients

through consultant rooms. Through the new PBAs endoscopy and colonoscopy, PBAs will be

developed to combat issues with training in this area. General Surgery is also proposing a new

accreditation standard for all new post applications whereby the new post must have access to

outpatients, seeing both new and follow-up patients.


GG Options for increasing trainee access to endoscopy for General Surgery trainees remains a

focus for the New Zealand Training Committee. At the Hospital accreditation visits in March

2017, several hospitals were noted to have the capacity to include more sessions for trainees

but there lacked enthusiasm to change this. This is being followed up in 2018 with two hospitals

where this was considered to be fairly easy to rectify within a short time span. The New

Zealand Training Committee is also looking at basic endoscopy training skills which may lead to

currently accredited hospitals being more willing to allow trainees access to endoscopy suites

once completed.


GG AOA is actively working to address the lack of outpatient experience, in NSW in particular. In

order to maintain accreditation, training sites are required to put alternative arrangements in

place to ensure trainees have sufficient outpatient experience. For example, a training site may

document an arrangement for trainees to go to a consultant’s private rooms on a weekly basis.

The new accreditation standards (to be rolled out in 2019) are more streamlined and targeted.

These standards, along with new monitoring processes, will ensure this requirement is met.


We currently achieve this.

182




No significant developments. OHNS insists on a comprehensive outpatient experience as part of hospital

accreditation.

Paediatric Surgery

No significant developments.

The training program is bi-national and trainees are expected to spend a minimum period of twelve months

in at least two training regions in Mid and Senior SET training.

The Board of Paediatric Surgery believes that diversity of training experience is acquired by spending time in

a number of training centres. This facilitates exposure to the full scope Paediatric Surgery practice, and the

breadth of training experiences.


The Commonwealth Government’s Specialist Training Program (STP) was identified by the Board as an

ideal mechanism for expanding SET opportunities into non-traditional settings (private hospitals and practice

locations). In 2017, the specialty was informed that the government would cease funding for Plastic and

Reconstructive Surgery. Following strong advocacy, funding was confirmed in late October 2017 for five

hospitals (one being subject to an approved accreditation status). The major challenge for the specialty is

changing the perceptions of aesthetic surgery and balancing those with the political pressures, which force

public hospitals to limit exposure to aesthetic components of Plastic and Reconstructive surgical procedures.

Alternative funding models are being investigated, noting that these are institution-driven initiatives. The

Board collaborates with the Australian Society of Plastic and Reconstructive Surgery Council to

communicate the gap in training opportunities within the Australian Society of Plastic and Reconstructive

Surgery membership. Advocacy with the subspecialty aesthetic association (February 2018) has led to

greater transparency of appropriate conferences and activities for SET trainees to attend and augment their

aesthetic training.

A deeper analysis of accredited SET PRS hospitals revealed three additional private hospitals involved in

SET training that were not previously reported to RACS for its AMC reports. This brings the total to eight

private / aesthetic training positions, of which four are STP posts and four are private hospitals.


The NZBPRS recognises the importance of aesthetic surgery within PRS and recommends trainees attend a

minimum of 1 full day (2 sessions) per month. We continue to monitor access to this as it is an area of the

Curriculum that we are concerned has the potential to be affected as exposure is dependent on access to

private hospitals.

Urology

No progress

Vascular Surgery


The training program is bi-national and trainees are expected to spend at least one year in an interstate or

overseas post. The concept is that trainees will be exposed to a variety of settings that may vary from state

to state.

183




Condition 14 For all specialty training programs, develop curriculum maps to show the alignment of learning activities and compulsory requirements with the outcomes at each stage of training and with the graduate outcomes. This could be undertaken in conjunction with the curricular reviews that are currently planned or underway. (Standard 4.1.1)

To be met by 2021



There is currently in place a comprehensive curriculum map for SET 1 to SET 6 trainees. All the compulsory

activities are recorded in a spreadsheet and trainees are reminded of their progress. Supervisors are

encouraged to report under-performing trainees and any trainees in question are discussed at board

meetings (held three times per year). The trainee (and the unit supervisor) also submit a longitudinal

mapping of their progress.

General Surgery

Will be undertaken as part of next curriculum review in line with the change in the training program to a five-

year competency- and time-based program

Neurosurgery

Nothing new to report.


As part of the AOA 21 program, AOA has a framework which outlines expectations of performance for each

stage of training. Learning opportunities have been broadly mapped to the curriculum competencies.


We have completed this. This is also part of the current curriculum review with the AOA.


This is an integral part of the new curriculum.

Paediatric Surgery

To be undertaken with our curriculum review.


Not yet occurred. To be advised.


This will be part of the curriculum review currently in process.

Urology

The new curriculum in formulation will have clearly-defined levels of progression with the required standards

for the trainees documented to ensure consistency of educational goals and assessment.

184



Vascular Surgery

In progress.

185




Areas covered by this standard: assessment approach; assessment methods; performance feedback;

assessment quality





HH Review the compulsory General Surgical Science Examination requirement in terms of usefulness, preparation time and financial burden for those who are not selected for entry into surgical training. (Standard 5.2.1)

II Review whether the Clinical Examination remains an essential assessment task, given that the 2016 Review of Assessment Report notes its poor reliability and trainee feedback questions its validity. (Standard 5.2.1)

JJ For all surgical specialties, adopt behaviour-related reporting (i.e. descriptive of the key features) rather than simple scoring for all work-based assessments. (Standard 5.2.3)

KK Explore the use of multi-source feedback for all surgical training programs at set points throughout training. (Standard 5.3.1)

LL Review whether the term ‘essay-type’ is appropriately used in all its current contexts. Where essay-type questions are used, consideration should be given as to whether they could be replaced with short-answer type questions. (Standard 5.4.1)



HH Successful completion of the compulsory Generic Surgical Science Examination (GSSE) prior to

SET application is a reinstated old policy. With the previous policy, there were many late-SET

trainees who were dismissed from the training program for failing the GSSE.

II Standard 5.2.1 Work in progress.

The Board may consider abandoning the Clinical Examination (CE). The Board felt that the CE

is too generic and has no relevance to Cardiothoracic training. The Board is currently waiting for

the Examination Committee to provide a detailed report of any proposed changes. At the recent

Selection Workshop held in April 2018 at RACS, we were informed that passing the CE is a

strong predictor of success in passing exams later in SET.

JJ Behaviour-related reporting is in place via the end of term assessment. Supervisors are

encouraged to report any inappropriate or unacceptable behaviour.

KK A 360o multisource feedback is already in place for SET 1 trainees.

LL There is no significant development.

186




II: The Board has removed the Clinical Exam as a requirement for training, effective from 2019.

KK These are used for trainees on performance management plans (PMPs), however, introducing

MSF for the number of trainees in General Surgery is not a viable option at this stage. The

usefulness of this tool needs to be considered.


II: The Board has removed the Clinical Exam as a requirement for training, effective from 2019.

JJ: The new EPAs will detail behaviour more clearly in assessable scenarios.

KK Nothing specific to NZ, although they are widely used for struggling trainees and those on

probation.


II The Clinical Exam is no longer a requirement for Orthopaedic training

JJ The AOA 21 Research Project included a phased introduction of workplace-based

assessments, both for learning and of learning, based on the principles of programmatic

assessment developed by van der Vleuten and Schuwirth. A suite of workplace-based

assessment tools, all delivered through a smartphone App, including an eLogbook and a

trainee-initiated Feedback App, encourage deeper learning through concepts of ‘entrustability’

and effective feedback.

The following purpose-built workplace based assessment tools have been implemented:

Surgical Skills Assessment (observation of procedural skills)

Patient Consultation Assessment (observation of initial assessment of a patient)

Management Plan Assessment (observation of development and implementation of a

patient management plan)

Case-based Discussion (structured discussion with the trainee about the trainee’s

management of the case and rationale for clinical decision-making)

Workplace-based assessments are benchmarked at the competencies articulated in the

curriculum. Trainees are then assessed against their demonstration of those competencies.

Trainees are assessed on a global scale, indicating their ability to provide effective patient care

for the next similar case. The trainee has achieved competence with that particular clinical

activity when the assessor is confident that, for the next similar case, they or a colleague would

not need to provide any input.

The aim of these assessments is trainee learning. Rather than a pass or fail assessment, these

tools provide an opportunity for trainees to receive feedback on their clinical skills. Items on the

WBA forms highlight specific aspects of the clinical activity, and prompt the assessor to prompt

feedback on Foundation Competencies (non-technical skills) as well as competencies related to

medical and surgical expertise.

AOA has also implemented completion of regular Feedback Entries. It takes approximately 60

seconds to make a Feedback Entry on the AOA Training App and allows for multiple samples of

feedback across a range of contexts and competencies to be collected. Trainees are

encouraged to initiate feedback entries.

Feedback focuses on foundation competencies, as well as medical and surgical expertise, e.g.:

Communication on the ward

187



Teamwork in theatre

Decision-making while on call

Presenting at a meeting

Professionalism observed in the ED

Its process encourages ’in the moment’ feedback when an observed trainee-trainer interaction

occurs.

Either party suggests a feedback discussion using the Feedback App

A feedback conversation occurs about the specific event

Trainer or trainee enters into the Feedback App a brief summary, for reflection on action or

as a reminder regarding a suggested action for the future

Feedback is based on ‘observation, review and reflection’. It is anchored in readiness for

practice and provides for trainees a ‘snapshot’ of what is expected and how well they are doing

in demonstrating competence and good professional practice. Its focus is on what went well

and/or could be improved – and includes documenting a recommended action for next time in a

similar setting.

Trainees are encouraged to seek feedback from a number of consultants and across a range of

contexts and competencies.

Trainees complete a 3-monthly Performance Appraisal with their Trainee Supervisor to monitor

performance and a 6-monthly Progress Review to monitor their progress through the stages of

training. Progress through stages of training is competency based.

KK Covered below at condition 15, below.


KK We are exploring the use of multisource feedback for the surgical training program.


HH The Board of Otolaryngology Head and Neck Surgery has removed the requirement for trainees

to complete the Generic Surgical Science Examination.

II The Board has also removed the requirement for SET trainees to complete the Clinical

Examination.

JJ WBAs implemented in 2018 rely substantially on formative feedback to trainees.

KK Multi-source feedback via a 360o evaluation is currently conducted for trainees who have been

placed on probationary training. The Board is considering the use of multi-source feedback for

all trainees at the Novice Level of training i.e. those trainees in the first 24 months of training.

LL There have been no significant developments against this. The OHNS Examination Board

continues to find essay questions useful in the Fellowship examination.

Paediatric Surgery

HH The Generic Surgical Sciences Exam became a pre-requisite to selection in 2016.

II The Board of Paediatric Surgery agreed in February 2018 that the RACS Clinical Examination

will be a pre-requisite to selection.

KK The Board of Paediatric Surgery conducts 360o evaluation surveys in SET 1.

188




HH, II and LL are RACS managment responsibilities

JJ Under development via implementation of EPAs into assessment tools for draft revised

curriculum (by mid-2018).

KK Multisource feedback (MSF) is mandated during probation and is encouraged for voluntary

trainee-led self-development. In late 2017, one trainee voluntarily used the MSF tool.


II The NZBPRS has reviewed the Clinical Exam with regard to PRS and has provided feedback to

the Surgical Sciences and Clinical Examination Committee that the NZBPRS would like the CE

exam to be aligned with GSSE and be moved pre-SET

HH The GSSE is reimbursed in NZ so is not a financial burden to those who sit it and do not pursue

a surgical career.

KK Multisource feedback is utilised where appropriate for Performance Management Plans.

Urology

The Board of Urology has discussed the role of the Clinical Examination and its timing. The ability of the

examination as a predictor of trainee progression across multiple specialty areas must relate to its potential

to discriminate on the basis of non-technical/foundation competencies. Targeting these as the primary

assessment focus for the clinical exam may allow identification of trainees ‘at risk’ in these areas in the early

stages of training, facilitating early remedial action as required.


Condition 15 Respond to the 2016 Review of Assessments Report by Cassandra Wannan by noting whether recommendations have already been implemented, require implementation or are rejected, including a rationale for the latter. (Standards 5.2 and 5.4)

To be met by 2018



The Board are happy to work with RACS to improve our work-based assessments.

General Surgery

The Board has approved the move towards entrustable professional activities (EPAs) and procedure based

assessments (PBAs). A more detailed plan will be presented over the next six months.

Neurosurgery

Nothing to report.


All recommendations have been addressed as part of the AOA 21 Research Project Assessment Strategy

(see above).

189



With regard to recommendation 8 for implementation of an MSF, consideration was given to mandating the

use of MSF routinely throughout training as part of the AOA 21 Project. However, the decision was made to

focus on gathering feedback via the Feedback App.

MSF is used in circumstances where a trainee requires additional support as an element of a performance

improvement plan. AOA is currently building an online version of the MSF tool for use by trainees and

Fellows (as part of CPD).


The NZOA is currently working with the AOA to implement workplace-based assessments in 2019.


WBAs are being reviewed as part of curriculum development. The Board is considering implementation of

EPAs and entrustability scales, the Board has established standards of performance at each stage of

training. The Board will adopt the surgical supervision document produced by RACS which will augment

training of raters. Clinical activities are assessed multiple times and are completed by different assessors

where possible. OHNS surgical supervisors have completed the FSSE course. MSF is not used as a

standard tool, but is used for trainees in difficulty. The new curriculum integrates programmatic assessment,

providing trainees with a portfolio of assessments.

Paediatric Surgery

In 2017 the Board of Paediatric Surgery revised the trainee assessment forms to better reflect competency-

based training and better track trainee progress. The Board altered descriptors and placed SET level

appropriate benchmarks and as such created assessment forms for each SET level.

A Global Assessment for each area of assessment was added into the trainee assessment forms to clearly

show the level of competency the trainee is at and whether further training and study is required.

A section titled “Current Learning Goals” was added to each assessment form to promote learning, track

progress and highlight areas for development; also providing an opportunity for constructive feedback.

The revised forms were sent to all trainees and surgical supervisors for their feedback prior to submitting the

forms to RACS Education Board for approval. Further feedback will be sought from the trainees and surgical

supervisors now that the forms have been in use for 12 months.

360o evaluation forms are mandatory for SET 1 trainees and are conducted twice a year. The Board recently

reviewed the list of hospital contacts that trainees are required to nominate and increased the number from 6

to 8. Trainees are now required to nominate a Registrar at the same level as they are, a registrar from

another specialty, and a resident. In addition, they must also nominate medical nursing staff and

administration staff (non-medical).

The Board will look at reviewing the Mini-CEX and DOPS forms to provide behavioural descriptors in the

coming months.


The Board’s Curriculum Review Working Group (CRWG) has completed a draft competency-based

curriculum and is currently undertaking an initial consultation period with key internal stakeholders (trainees,

trainers and supervisors). Thereafter, a wider stakeholder cohort will be consulted. The CRWG also has a list

of EPAs that will be further discussed and approved in June. At that time, we will also be looking at

Procedure Based Assessments (PBAs) and modified DOPS and Mini-CEX tools. There will also be

considerable time spent on rating scales and real-world applicability.

Please note ABPRS responses to the Wannan report below. (Wannan report recommendations are

numbered in bold font and ABPRS responses are in normal font.)

190



1. Review WBA tools and their implementation: specialties review the WBAs to increase validity, reliability

and educational impact. This may entail increasing the frequency of assessments and the diversity of

assessment methods.

Work in progress (WIP) via the CRWG. Workshops held: March 2018. Workshop scheduled June 2018

2. Improve clinical relevance: Review content of WBAs to make these formative assessments more

meaningful, to promote learning and to better track trainee progress through training. The introduction of

entrustable professional activities may contribute to this outcome.

Work in progress via CRWG workshop (June 2018) to develop clinically relevant EPAs, modified DOPS, Mini

CEX and so forth. An initial list of applicable EPAs has been formulated. This list will be further developed at

the next CRWG workshop.

3. Blueprint WBAs onto the curriculum: specialties establish standards of performance and clinical

activities relevant to trainees at each stage of training. WBAs can then be appropriately configured to these

activities and standards.

This is in place. The Senior Examiner for Plastic Surgery also commenced a blueprinting process in late

2017 to the competency-based curriculum. The process is pending release of a final approved curriculum.

4. Use Entrustability Scales to improve reliability of WBA ratings: entrustability evaluations are based

on the amount of supervision a trainee requires to perform a task. Specialties need to determine levels of

competence to be demonstrated by trainees in activities as they progress to independent practice.

As above for recommendation 2.

5. Train raters: raters/assessors should be trained in the use of assessment tools to maximise reliability and

validity, e.g. Frame-of-reference training that ensures all raters are aligned to the scale principles.

To be done after new assessment tools are approved by the Australian and NZ boards.

6. Use multiple assessments and assessors: clinical activities should be assessed multiple times to track

trainee progress and provide relevant feedback. Ideally, assessments would be completed by different

assessors during a rotation.

In place for many years. All SET levels are subject to one formative and one summative assessment per 6-

month rotation. All surgical unit assessors contribute to the professional performance assessment

SET 1 and SET 2 trainees must also submit one satisfactory assessment from each of DOPS and Mini CEX

for every 6-month rotation. Any trainer can be nominated by a trainee to conduct the assessment.

Trainees on probation, or placed on performance management plans, must conduct additional formative

assessments as specified by the Board or the trainee’s supervisor. Multisource feedback is used for all

trainees on probation with evaluators selected from a wide range of healthcare professionals and

administrative personnel.

7. Provide meaningful, constructive feedback: WBA feedback should be structured and include a specific

action plan that highlights future areas of development, agreed upon by the trainer and the trainee.

In place. Remedial Action Plans using SMART Goals are a requirement of formal performance management

(2 or more borderline competencies, 1 poor competency from any PPA meeting)

8. Introduce multi-source feedback: specialties are advised to consider the use of multi-source feedback

as a standard WBA tool.

In place since 2014 for trainees on probation. Not considered at this time as a standard for all trainees.

9. Introduce assessment portfolios: assessment portfolios may increase continuity in learning across

rotations.

Not in place – the Board has concern for the introduction of unconscious bias.

191



Where a trainee’s performance included one borderline competency grade at the summative assessment

(end of term), the next supervisor is informed of the competency and any specific comments from the

assessment form.

Trainees entering probation (unsatisfactory PPAs – two or more borderline grade scores or one poor score)

must formulate a Remedial Action Plan within 10 days for the ensuing term – this is informed by the most

recent assessments (final PPA at end of term).


The Board has written to RACS indicating their preference for the Clinical Examination to be a pre selection

requirement. We are awaiting a response.

At present we are collaboratively revising the PRS curriculum with a focus on competencies (with ABPRS)

and WBAs are a major focus of this. We are developing a communication tool to complement the mCEX and

DOPs. Each tool is being evaluated and revised. Stakeholders will be included in the review prior to

implementation as well as preparing and educating trainers and trainees on these revised WBAs at an

appropriate time.

At present MSF is used for Performance Management Plans, especially for non-technical areas.

Routine assessments include formative and summative reviews which incorporate self-reflection and

feedback. We have revised our PPA form to be clearer with respect to trainee behaviours, actions and

outcomes, and the ratings on the form, with positive feedback from trainees. DOPs and mCEX would be the

most commonly used WBAs and are required for SET 1 and SET 2 and are also incorporated in

Performance Management Plans.

Urology

Modification of the structured oral exam has been undertaken, noting the poor inter-rater reliability evidenced

for this component of the FEX by Wannan. The written component of the FEX remains short answer

question, although the format has again been modified since the Wannan report, with a greater number of

shorter length questions now implemented, with a clear template ‘model answer’ for each question. The

implementation of MCQ type questions for the FEX written component instead of essay type questions as

per Wannan recommendations (given the poor inter rater reliability in written components) at this juncture is

not planned, given the substantial difficulty in validating the sizeable bank of MCQ type questions which

would be required for the FEX.

In regard to work based assessments, DOPS and MiniCEX are employed as mandatory assessment

components for trainees. Multisource feedback (MSF) is utilised selectively, currently for trainees suspected

of having non-technical competency concerns. More widespread use of MSF will be considered during

curriculum review, with concerns regarding the relatively small pool of relevant contributors for MSF should

its use be employed too generously. The revised curriculum is anticipated to incorporate a much greater use

of WBA, particularly EPAs, and is expected to be implemented as soon as feasible.

Vascular Surgery

These items have been addressed by the BRIPS action plan.


Condition 16 Implement appropriate standard setting methods for all specialty-specific examinations (The AMC recognises that at least three specialties are already compliant in this respect). (Standard 5.2.3)

To be met by 2019

192





Specialty-specific examination is already in place at Mid SET.

General Surgery

SEAM has a standard-setting process approved by RACS and available in the Regulations.

Neurosurgery

There is no Neurosurgery specific examination during the training program. There is a Neurosurgery

Anatomy Examination held as part of the selection process. Each question is reviewed by a committee of

neurosurgeons and a difficulty level assigned. There is a set formula for the construction of the examination

using a consist mix of difficulty levels. Statistical data on the performance of questions is then reviewed after

the examination.


No change. OHNS continues to work with RACS to define standards of performance and set ‘pass’ scores

at each sitting of the specialty SSE.

Paediatric Surgery

The Board of Paediatric Surgery has a Court of Examiners, and the Senior Examiner is a member on the

Board, who is responsible for standard-setting in the exams.


The Australian Society of Plastic Surgeons and the Board are precluded from examination administration,

management and standard-setting. RACS has absolute control over this area.


The Fellowship Examination (FEX) is written, delivered and marked by RACS.

Urology

The Specialty-Specific Surgical Sciences Examination (SSE) (Urology) altered the standard-setting process

during the Wannan review period, and the effectiveness of current standard-setting methods will be subject

to further review.

Vascular Surgery

The Board of Vascular Surgery has a Court of Examiners, and a member on the Board of Vascular Surgery

who is responsible for standard-setting in the Exam. The Senior Examiner is also appointed as a member of

the Board of Vascular Surgery.

193




Areas covered by this standard: program monitoring; evaluation; feedback, reporting and action

Summary of College performance against Standard 6




MM Explore with trainees how response rates to surveys on training posts could be improved. (Standard 6.1.3)

NN Implement the planned New Fellows’ Survey to evaluate their preparedness to practice and the annual survey of trainees who leave surgery without completing the program. (Standard 6.2.2)



MM Feedback via RACS Trainees’ Association (RACSTA) is in place reporting to BSET and the

Cardiothoracic Board. There is a co-opted trainee representative as a committee member for

BSET and the Cardiothoracic Board. They both are full members of the respective boards and

have equal right to vote.

NN Standard 6.2.2 - No major development

RACS runs regular workshop to prepare Fellows to enter surgical practice. However, there is no

new Fellows survey to evaluate their preparedness to practice. Younger Fellows (<10 years

from obtaining Fellowship) are actively recruited to join both the Board as well as ANZSCTS.

General Surgery

MM NZ specific - Responses to surveys, particularly after Term 1 remain quite poor which is

considered to be partly due to the fact that trainees remain in the same training hospital all year

and are not willing to participate in a survey where negative feedback can be traced back to

them as individuals. Many hospitals only have 1 or 2 trainees, so feedback although collected

anonymously, is often quite easy to match with individual trainees. It is considered that modest

improvements might be achievable but even if completion of surveys is mandated, it is unlikely

to achieve 100% compliance. Mandating completion of surveys will necessitate removing

anonymity which is very likely to reverse any intended effect.

MM Au: GS struggles with this, however mandating a response would remove the natural feedback

provided and the willingness of trainees to report issues, as mandating a response would

remove the ability to de-identify trainees. Trainees may feel ‘pushed’ or forced to complete

these surveys and meaningful data may be lost.

194




MM AOA has been working with the Australian Orthopaedic Registrars’ Association (AORA) to

increase the response rate on the twice-annual trainee survey. The response rate for the most

recently completed trainee survey was 77%.


No change.


No significant developments. The Board is interested in implementing the planned new Fellows survey.

Paediatric Surgery



MM Informal discussions with trainees have commenced (March 2018). Qualitative feedback was

sought by survey at the annual SET conference (March 2018).

A mentor program is in place in WA (before 2017), and NSW (Dec. 2017). Mentoring sessions

provide an opportunity for the mentor to convey board standards to the mentee in a supportive

environment.

NN RACS responsibility


MM Improving the response rate and reviewing responses to the trainees’ survey is a project

recently taken on by the external and trainee representatives of the NZBPRS. There is a plan to

schedule time for the survey at the annual training weekend to promote participation. Previously

the survey was emailed out.

NN No progress

Urology

No progress

Vascular Surgery

No significant changes


Condition 17 Develop an overarching framework for monitoring and evaluation, which includes all training and educational processes, as well as program and graduate outcomes. (Standard 6.1, 6.2 and 6.3)

To be met by 2019

195





The Board meets three times per year and all trainees are discussed in detail. Trainees’ progress is

monitored and evaluated via their log books, DOPS, MiniCEX, and TEF assessments. The Board and

ANZSCTS are also tracking post-Fellowship surgeons’ activities in terms of employment and any restriction

of their practice by APHRA. RACS has records of all Fellows who are CPD compliant.

General Surgery

BiGS will commence an evaluation on the research requirement beginning with a survey in June 2018. The

new GS program will also include a comprehensive evaluation process.

Neurosurgery

Nothing new to report.


AOA has a monitoring and evaluation framework already in place.


At its regular meetings, the OHNS Training Board continually monitors training, assessment, and research

activities, and trainee performance and progress. The Board implements decisions arising from these

discussions.

Paediatric Surgery

No progress to report.


To be advised.


No progress

Urology

No progress

Vascular Surgery

No progress to report.


Condition 18 In conjunction with the Specialty Training Boards, develop a policy to manage the situation whereby a trainee has been inadvertently identified as a result of providing feedback. (Standard 6.1.3)

To be met by 2018

196





No significant development

Will meet standard 6.1.3 by formalising the policy below:

The Board has an unwritten policy to protect the trainee and their anonymity and any complaint is respected.

The trainee maintains the right to remain silent unless he/she chooses not to. If this is breached, the Chair

will discuss this with the trainee and the other party involved.

Neurosurgery

Neurosurgery collects evaluation forms from trainees regarding experiences in their training posts on a 6

monthly basis. Individual submissions which are identifiable are only released to the Trainee Representative

on the Board. The Board only sees a combined report for all positions with no identifiable data. Collated

data over a five-year period is used for the hospital accreditation purposes to minimise the possibility of

individual trainees being identified. In a small specialty, this is a big challenge.


AOA is happy to contribute to development of such a process


This is a RACS policy


Once the policy has been developed by RACS, it will be incorporated into the OHNS training regulations.

Paediatric Surgery

Once the policy has been developed by RACS, it will be incorporated into the Paediatric Surgery training

regulations.


Information on RACS complaints management processes (standard operating procedures) was requested to

compare against Australian Society of Plastic Surgeons processes.

All complaints received by board representatives are reported confidentially at a board meeting and, where

permission is granted from the complainant and further reporting is warranted, the complaint could be

reported to the complaint hotline or RACS Legal Counsel. Board meeting records are confidential and not

disclosed.

Summary of complaints in 2017 and 2018:

Region NSW; Year 2017; board action taken: Complaint held over on request of the trainee until conclusion

of employment. Thereafter, the complaint was noted at board meeting. The trainee’s name was not

disclosed. No further actions taken.

Region WA; Year 2017-2018; board actions taken: A trainee flagged some concerns to the Board. The

trainee did not provide consent to the Australian Society of Plastic Surgeons to escalate the concerns or

progress them to a formal complaint. Australian Society of Plastic Surgeons informed RACS Complaints

Department and RACS General Counsel of the de-identified concerns.

197




This is a major concern to the Board – in particular as some training hospitals may only have one or two

trainees. The Board will review and comment on the document circulated from BSET at its next meeting and

actively seek involvement from the external and trainee representatives.

Urology

Awaiting further guidance from RACS as to how to proceed. Currently confidential post assessment

information from trainees is not passed directly to the training posts. DBSH issues are referred to RACS and

not processed via the Board of Urology. In the event of a trainee being considered at risk to their wellbeing or

training opportunities, either related to inadvertent identification from feedback or to the underlying issue

raised, the Board of Urology would relocate the trainee from the post.

Vascular Surgery

RACS to provide a policy at BSET for specialty board review.


Condition 19 Establish methods to seek confidential feedback from supervisors of training, across the surgical specialties, to contribute to the monitoring and development of the training program. (Standard 6.1.2)

To be met by 2019



All surgical supervisors and heads of department convene at the ANZSCTS annual meeting. This meeting is

also minuted. There is easy access to the Chair and any board members should there be any concerns

regarding any training issues. All the trainees have either direct access to a board member, the Chair and

the Trainee Representative to raise concerns regarding their training.

All feedback regarding training is taken seriously by the Board, is tabled at every Board meeting and

appropriate action taken.

Neurosurgery

The NSA and Board of Neurosurgery hold supervisors’ meetings every two years. This has resulted in

significant input by supervisors into the structure and management of the training program and the

assessment tools used. The next meeting is in 2019.


AOA routinely seeks feedback from supervisors twice annually. Feedback is also sought specifically at

various touchpoints of involvement (e.g. bone camp, workshops, trial exams etc.)

In addition, supervisors are actively involved in committees and working groups involved in review and

development.


We currently receive this feedback.

198




The surgical supervisors of each state meet bi-annually to discuss training issues. This feedback is provided

to the Board through the regional chairs.

Paediatric Surgery

The Board of Paediatric Surgery meets with the surgical supervisors once per year. This meeting provides

the supervisors with opportunities to provide any feedback regarding the training program. We have also

requested financial support to have annual seminars with supervisors of training and the Board of Paediatric

Surgery to further improve communication and skill development of supervisors.


Handled via subcommittee relationships to filter up to the Board in a confidential manner where appropriate.


All Supervisors are NZBPRS members so have a forum for discussing and improving the SET programme.

Urology

No progress

Vascular Surgery

The Board conducts two supervisor meetings each year, which are specifically held to seek supervisor

feedback on the training program.


Condition 20 Develop and implement completely confidential and safe processes for obtaining—and acting on—regular, systematic feedback from trainees on the quality of supervision, training and clinical experience. (Standards 6.1.3 and 8.1.3)

To be met by 2019



This is done via the Trainee Representative on the Board and all feedback is directed to any board

members. Actions have been taken based on this feedback.

General Surgery

General Surgery has regulations pertaining to hospital post feedback from trainees which details the process

on how the feedback is de-identified

Neurosurgery

See above. Already in place and has been for more than 7 years.


AOA routinely seeks feedback from trainees twice annually. Feedback is also sought specifically at various

touchpoints of involvement (e.g. bone camp, workshops, trial exams etc.).

199



In addition, trainees are actively involved in committees and working groups involved in review and

development.


This is done as part of the hospital inspection.


Feedback from trainees is discussed with the Board through the trainee representative. In 2017, following

an extensive systematic review of Otolaryngology training, numerous changes were implemented into the

training regulations. OHNS NZ conducts yearly anonymous surveys to obtain trainee feedback. At the

training week interviews, feedback is sought on the posts and any other issues.

Paediatric Surgery

Currently all trainees are interviewed at our Registrar Annual Training Seminar. More formal feedback during

this process will be developed to achieve this goal.


The Australian Board of Plastic and Reconstructive Surgery routinely seeks trainee feedback (at the

conclusion of each 6-month rotation). These reports are statistically analysed ahead of the re-accreditation of

hospital training posts and also reviewed individually for signals requiring attention by the Board. Data is

confidential, with only aggregated (de-identified) information shared, where relevant.


There is an annual trainee survey (anonymous) that will be included in the annual training conference to

ensure responses are obtained. The trainee representative and external representative will review responses

and report back to the Board.

Urology

The curriculum review is likely to encompass an assessment of graduate outcomes, which would include

confidential feedback assessment from trainees exiting the program. In addition, the current trainee

representative system affords trainees the opportunity for confidential feedback to their elected peer who can

raise issues directly at the Board of Urology level.

Urology conducts a confidential training post feedback process with all trainees annually. A summary of

findings is provided to the Board and to hospital post inspectors.

Vascular Surgery

The Board of Vascular Surgery is currently in the process of reviewing the trainee evaluation forms submitted

annually for each accredited hospital post.


Condition 21 Develop formal consultation methods and regularly collect feedback on the surgical training program from non-surgical health professionals, healthcare administrators, and consumer and community representatives. (Standard 6.2.3)

To be met by 2020

200





A mandatory 360o evaluation survey and feedback form are sought from non-surgical health professionals

when assessing the progress of SET 1 trainees.

Neurosurgery

Nothing to report.


The Orthopaedic Training Board now has a Cultural and Consumer Adviser to provide this feedback.


No progress.

Paediatric Surgery

RACS to provide.


To be advised.


No progress.

Urology

Mandatory 360o evaluation surveys and feedback are sought from non-surgical health professionals when

assessing the progress of SET 1 trainees.

Vascular Surgery

RACS to provide.


Condition 22 Report the results of monitoring and evaluation through governance and administrative structures, and to external stakeholders. It will be important to ensure that results are made available to all those who provided feedback. (Standard 6.3)

To be met by 2020



Reporting and monitoring of complex issues are guided by the recommendations of College Council, BSET

policies and the College’s legal counsel to mitigate adverse risk.

Neurosurgery

Nothing to report.

201




No progress.

Paediatric Surgery

RACS to provide.


Monitoring and evaluation is well-established via mechanisms of the regional subcommittees through to the

Training Board and then the Board of SET.

The Australian Society of Plastic Surgeons invites RACS management and surgical leadership to Board

meetings on a regular basis to support sharing of information. For example, the Director of Education and

Training and Administration in early 2017 and the Dean of Education in late 2017 and planned again for

2018. Similarly, RACS Manager, SET has been invited to a board meeting.


No progress

Urology

No progress

Vascular Surgery

RACS to provide


Condition 23 Develop and implement an action plan in response to the 2016 Leaving Surgical Training study. (Standard 6.2)

To be met by 2019



No significant development

Exit interviews, including vocational counselling and employment options, are usually conducted in-house

and via Board members.

Neurosurgery

Nothing to report.


We have not had this issue to address at this stage.


The OHNS Training Board is addressing the need for flexible training. Flexible training positions have been

filled in New Zealand, Victoria and Queensland. All requests for maternity leave are granted. The Board has

encouraged the visibility of role models.

202



Paediatric Surgery

RACS to provide.


RACS responsibility


No progress

Urology

No progress

Vascular Surgery

RACS to provide

203




Areas covered by this standard: admission policy and selection; trainee participation in education provider

governance; communication with trainees; trainee wellbeing; resolution of training problems and disputes





OO In relation to selection into the surgical training programs:

(i) Evaluate the objectives of the selection process to ensure they are both clear and consistent across all surgical training programs.

(ii) Develop a process to ensure that updates and changes to entry prerequisites undergo a consultation process, and provide appropriate lead time for prospective applicants to meet them.

(iii) Explore the means by which prevocational work performance and technical ability may be more appropriately assessed as part of the selection process.

(iv) Examine the key discriminators (e.g. academic record, research, experience, interview performance) in the current selection process and whether these are the most relevant for predicting performance both as a trainee and as specialist. (Standard 7.1.1)

PP Implement a program to increase awareness of the presence and role of the RACS Trainees’ Association (RACSTA). (Standard 7.2 and 7.3)



OO(i) The selection process information is available and the scoring system is clearly outlined. Any

ambiguity is revised by the Board. The scoring system is marked by two board members and

any unmatched scoring is referred to the Chair for re-marking. The Board recognises that

scoring can be quite subjective and this approach provides the best consistency.

OO(ii) The Board reviews the selection process and scoring system yearly and any changes are

approved by EB. Implementation of these changes, take place in the following year of that

approval.

OO(iii) The selection process accepts recognition of prior learning subject to Board approval. RACS is

currently evaluating work place assessment, which is difficult to administer with the current

resources available.

OO(iv) The referee reports have been recognised as a challenging predictor of training performance.

The Board will be evaluating its scoring system in the selection process. Recommendations

from the recent selection process workshop held in April will be available shortly.

PP RACSTA is already playing a significant role in the training program. Its awareness is well

advertised on the RACS website. All trainees have direct access to the Association. The

204



previous RACSTA representative sent out regular surveys to all the trainees. Whilst the number

of trainee responses is variable, RACSTA is continuously engaging all trainees to raise any

issues during their training. The BDSH survey was monitored in 2017. The RACSTA

representative provided a quarterly report at the BSET meeting.


OO(ii) Changes to selection have been steady for 2-3 years and the Board provides at least 12

months’ notice of any major changes to minimum eligibility.

OO(iv) Data on trainees who commenced in 2016, 2017 and 2018 has been collected to determine if

performance and ranking in selection is a predicator to performance in the training program

across assessments, exams and SEAM


OO(ii) The NZ Training Committee will continue to ensure major changes to pre-requisites are

signalled well in advance when possible.

OO(iii) The selection process for 2018 has been changed with regard the sourcing of referee reports in

that referees will no longer be able to identify the “answer” giving the candidate the highest

score via randomisation of the order of options.

OO(iv) NZ annually reviews the selection process to identify possible improvements. The NZ Training

Committee is keen to explore the possibility of using new selection tools, with support from

RACS to validate these, with the view to finding more discriminatory tools.


OO AOA has a process whereby significant changes to the selection process are flagged within the

Regulations at least a year prior to implementation.

AOA is currently investigating a more state-based approach to selection to facilitate applicants

training in their region of preference. This approach may utilise more formal banding of

applicants where scores are statistically equivalent. Planning is also underway to trial

situational judgement tests as part of the selection process.


We have an Education and Training Working Group that is currently progressing with this work. This work is

clearly documented.


The OHNS board is embarking on a thorough review of selection processes. Board representatives

participated in the selection workshop in April 2018. Recommendations from this workshop are being

implemented, specifically to evaluate prevocational work performance and technical ability as part of the

selection assessment. The key discriminators in the current selection process are being extensively

modified to ensure that they are relevant.

Paediatric Surgery



OO(ii) Commenced in February 2018 via the formation of a Selection Subcommittee with defined

terms of reference. The GSSE is a pre-requisite for selection since 2017. The Board

205



encourages RACS to build capacity within its examinations department to enable the Clinical

Examination as a pre-requisite

PP RACS responsibility


The NZBPRS attended the recent SET Selection Workshop held by RACS and as part of the exercise met

with the ABPRS to discuss a combined approach to SET selection tools. We agreed that we would work with

RACS to develop SJTs and introduce these. We agreed that the CV and referee reports could be minimum

requirements (as shown to be non-discriminatory with respect to SET performance by RACS data) and

interview referees with red flags on their reports. We would like the CE to be pre SET and the score and

attempts to pass available. As with other STBs we would then like SJTs to be performed to help refine the

potential applicants selected for structured interviews. The Board would welcome further interview training to

improve and refine this tool – which appears to be the only with an association with SET performance. We

would also like a limitation on the number of SET applications to no more than 3 if this is consistent across

all specialities.

Urology

No significant progress.

Vascular Surgery



Condition 24 Further develop the selection policies for each surgical training program, particularly with regard to the provision of transparent scoring of each element in the curriculum vitae and the standardisation in the structure of referee reports. (Standard 7.1)

To be met by 2020



Two Board members mark the scoring system and any unmatched scoring is referred to the Chair for re-

marking. The Board recognises that scoring can be quite subjective and this approach provides

transparency.

All interviewers are required to declare any conflict of interest. The scoring must be unanimous and all

records of the interview are kept.

Work is in progress to update selection process.


Regulations from 2018 have included the publishing of the scoring system for CV. Referees and interview

scoring have been published for several years.

Neurosurgery

Well defined and transparent selection process regulations are already in place and no significant changes

are anticipated. Data is being collected to evaluate the process over a five-year period.

206




Increasing the transparency of scoring of the curriculum vitae will be reviewed at the forthcoming Federal

Training Committee meeting.

AOA already utilises a standardised referee reporting tool.


This is currently done


OHNS has a transparent scoring system that is publicly available for the CV. The referee reporting process

is currently undergoing review.

Paediatric Surgery

The Selection Regulations are reviewed by the Board each year and are submitted to the RACS Education

Board for review.


Since 2009, the maximum scores for each selection tool were published for candidate applicants.

Since 2018 (approved 2017), the Selection Regulations provide clear and transparent maximum scores for

each question of the structured CV scores


NZBPRS reviews (and will amend if appropriate to improve the process) its selection process annually. In

2018 the referees will participate in telephonic interviews with the SET selection subcommittee. The Board

will discuss potential improvements at the next meeting following SET selection and the RACS SET selection

workshop with an aim to further improve selection.

Urology

Further selection refinements have occurred, with a highly standardised and transparent CV scoring scheme

already in place. Referee reports are also in the process of evolution, but the structure is well established.

Vascular Surgery

RACS to advise if this is not being met by the Board of Vascular Surgery


Condition 25 Clearly document and make publicly available the standard of entry into each surgical training program. (Standard 7.1)

To be met by 2018



The policy is already in place for Cardiothoracic Surgery.

207



General Surgery

Selection regulations already identify the standard of entry.

Neurosurgery

Already satisfied.


Eligibility requirements for applications to Orthopaedic training are clearly outlined on the AOA website.


This is included in our Regulations on our website.


Selection Regulations into the SET OHNS program are being updated for the 2020 intake.

Paediatric Surgery

The minimum eligibility requires for Paediatric Surgery are publicly available on the RACS website via the

Selection Regulations.

Applicants must score a minimum of 35 or more out of 55 for the combined structured Curriculum Vitae and

online referee report to be invited to attend an interview. Applicants who fail to achieve the minimum

standard score of 35 will not be considered further in the selection process.

Applicants must score a minimum of 15 marks out of a maximum of 25 of the total interview score to be

eligible to progress to the final stage of the selection process and be ranked with an overall score

The minimum standard score needed to be appointed to Paediatric Surgery training is 72%. Applicants who

do not achieve a combined score of 72% or above will be deemed unsuitable for training and therefore

unsuccessful in the selection process.


Completed since 2009.


The SET selection requirements are publically available on the RACS website via the SET Selection

Regulations and state eligibility requirements and the selection process (referee and candidate structured

interviews).

Applicants who satisfy the eligibility conditions in Section 2 of the NZBPRS Selection Regulations will be

ranked by the combined score of the CV and Reference Reports. Interviews will be offered based on a ratio

of four applicants to one post (i.e. 4:1). Applicants will be invited to interview based on ranked order. The

Board has established a subcommittee to investigate the possibility of introducing a minimum standard for

selection and their report is due by the end of September 2018.

Urology

The minimum entry standard for admission to the SET Program in Urology for selection in 2019 (2020 intake)

has now been established and endorsed by the Board of Urology. This will be published in November 2018

on the USANZ website.

208



Vascular Surgery

The Board advertises the selection regulations on the College website. These regulations outline the

selection process and standard for entry into Vascular Surgery.

209




Condition 26 Develop a policy that leads to the increased recruitment and selection of Aboriginal and Torres Strait Islander and/or Māori trainees in each surgical training program. (Standard 7.1.3)

To be met by 2019



The Board had approval for the inclusion of Aboriginal and Torres Strait Islanders to apply to the advanced

SET training program provided they reach the minimal standards


General Surgery has quarantined posts for the 2019 selection process

Neurosurgery

Nothing to report.


AOA endorses RACS ‘Aboriginal and Torres Strait Islander Surgical Trainee Selection Initiative’ policy.

Where scores are statistically equivalent at the cut off for offers, the Selection Committee will determine

which candidates receive an offer and in making any such determination will have regard to promoting

diversity within the training program.


We support components of the RACS Māori Action Health Plan


The Board has implemented the Aboriginal and Torres Strait Islander (ATSI) Selection Initiative.

Paediatric Surgery

The Board implemented the RACS Aboriginal and Torres Strait Islander Surgical Trainee Selection Initiative

for the 2019 intake.


Completed in 2017 and implemented for 2018.

Zero applicants identified themselves as Aboriginal and Torres Strait Islanders during RACS’ registration for

selection process in early 2018.


NZBPRS has initiated dialogue with NZAPS regarding an annual scholarship available to Māori and Pacific

Island medical students to attend the NZAPS ASM as a way of increasing awareness of PRS as a specialty

and a future career. This approach has been taken as we have received advice from several cultural

advisors including the Māori adviser to the MCNZ and a Māori advisor to RACS that this is culturally

acceptable whereas a selection pathway approach would not be.

210



Urology

The Board has acquiesced with proposed preferential selection for those meeting the minimum criteria, but

active processes will be explored to encourage and facilitate a greater number of Aboriginal and Torres Strait

Islanders applicants and mitigate any impediment to them meeting the selection criteria.

Vascular Surgery

The Board intends to implement the College policy on selection of Aboriginal and Torres Strait Islander

and/or Māori trainees in the 2019 selection process. The Board is working with the College to develop a

minimum standard for selection, which will allow the above to be implemented.


Condition 27 Promote and monitor the Diversity and Inclusion Plan through the College and Specialty Training Boards to ensure there are no structural impediments to a diversity of applicants applying for, and selected into, all specialty training programs. (Standard 7.1)

To be met by 2019



Policy is already in place.

Neurosurgery

Nothing to report.


AOA has adopted a Diversity Strategy with a vision to create a culture of inclusion that promotes and

enables all people into and within the profession of orthopaedic surgery to the benefit of the Australian

people.


We have reviewed the selection process to ensure diversity barriers, both real and perceived are removed.


OHNS has moved to minimise any impediments to diversity in selection. The OHNS trainee cohort is

culturally diverse and 32% of current OHNS trainees are women.

Paediatric Surgery

See response to Condition 26.


Planned commencement of discussion/consideration by the Australian Board of Plastic and Reconstructive

Surgery in July 2018


The NZ PRS trainees currently cover a diverse range of cultures and has a percentage of female trainees

which fluctuates between 45 – 61% in recent years.

211



Urology

The Urology selection interviews include assessment of Aboriginal and Torres Strait Islander and Māori

cultural awareness.

Vascular Surgery

See response to Condition 26.


Condition 28 Increase transparency in setting and reviewing fees for training, assessments and training courses, while also seeking to contain the costs of training for trainees and specialist international medical graduates. (Standards 7.3.2 and 10.4.1)

To be met by 2019



Fees for training are well publicised on the RACS website

Neurosurgery

The training fee determined by the NSA is set on a cost recovery basis. The Board does not charge

additional fees for NSA run training seminars which form a compulsory part of training. The examinations

ran during training by the NSA are also at no additional charge to trainees which include an MCQ

examination and Intermediate examination (Fellowship Examination practice written paper).


AOA undertook a facilitated costing exercise, which aimed to evaluate the actual cost of the activities

undertaken and delivered as part of the raining program in order to determine appropriate fees on a cost

recovery basis. This exercise effected both the Training Fee and fees for particular training activities such as

in training exams and courses. The process took into account staffing requirements, including time

commitments and levels of activity. This information feeds into work planning and role definitions within the

AOA team. Trainees were fully briefed on the costing exercise.


This is currently met.


The training fee determined by ASOHNS is set on a cost recovery basis and is published on the RACS

website. The OHNS board strives to minimise costs to trainees.

Paediatric Surgery

RACS to provide information.


Australian Society of Plastic Surgeons has been transparent with trainees in how its activity costing was

used to set the annual SET training fee in 2014 (the commencement of the five-year collaboration

agreement) and subsequent increases have been in line with education CPI.

212



Annual SET conferences are run to make a small surplus profit or break even.

Newsletter communications are used to communicate the annual SET fee.

Fees for 2019 are under consideration.


Training fees are publicly available on the RACS website. The NZ PRS Training fee is set by NZAPS

annually and the Board Chair and Trainee Rep have input into this.

Urology

Trainees are well informed of the direct costs of Urology training, and are provided with a breakdown of

these. Indirect costs are less clearly defined, and include RACS fees and indirect USANZ costs. Cost control

remains a priority.

Vascular Surgery

Usually the Specialty Board increases the cost with CPI.


Condition 29 Address trainee concerns about being able to raise issues and resolve disputes during training by ensuring there are mechanisms for trainees to do so without jeopardising their ongoing participation in the training program. (Standard 7.5)

To be met by 2019



Trainees are encouraged to raise concerns with regard to their quality of training. There are many avenues

for reporting to RACS. These can be reported directly to the Board, Department of Surgical Affairs and

complaints (on Line), via the trainee representative and directly through RACSTA.

The Board plans to engage the newly appointed external board member in the inspection process.

Neurosurgery

Trainees have been very engaged in the review and reconsideration process available in the training

program Regulations as previously reported.


AOA acknowledges trainee concerns regarding their ability to raise issues without impacting on their training.

AOA has seen a trend toward more willingness by trainees to speak out and will continue to foster this

confidence.


Informal feedback is regularly received from the trainees. Our Appeals Process has recently been developed

and approved by the Council.

213




The SET OHNS Training Regulations include Review and appeal processes in line with RACS policy. The

hospital accreditation process provides a mechanism to address trainee concerns with training positions in a

confidential environment.

Paediatric Surgery

To be confirmed.


Trainees are encouraged to deal with disputes locally in the first instance. Disputes that cannot be managed

locally can be escalated to the Regional Chair, Trainee Representative, Australian Society of Plastic

Surgeons office or the Board Chair directly.

Accreditation of training posts and approval processes for supervisors (that require at least three surgeons in

a surgical PRS unit) are complementary to support trainees and enable local resolution to issues. We require

independent supervisor from the head of unit positions, with exemptions applying to regional centres.

Several recent instances where trainees have raised concerns about the training environment, or the local

medical staff have been handled with the trainees best interests in mind. The Board’s governance structure,

including an external member and a trainee representative, ensures training matters are given a fair hearing.


Some units have appointed mentors who are not Supervisors and from other specialties.

Urology

No progress

Vascular Surgery

To be confirmed

214



Standard 8: Implementing the program – delivery of education and accreditation of training

sites

Areas covered by this standard: supervisory and educational roles, and training sites and posts





QQ Develop a policy that is adhered to by all Specialty Training Boards which stipulates the minimum advanced notice required prior to requiring commencement of new rotations and which also minimises the number of interstate /international rotations. (Standard 8.2.2)

RR Work with the jurisdictions to assist in preventing the loss of employment benefits when trainees transfer between jurisdictions. (Standard 8.2.3)

SS Consider how to expand the surgical training programs in rural and regional locations. (Standard 8.2.2 and 8.2.3)

TT Support collaboration amongst the Specialty Training Boards to develop common accreditation processes and share relevant information. (Standard 8.2.4)



QQ Before any hospital post allocations, the trainees are advised to select their preferred post for

the following year. This policy is implemented in an attempt to minimise interstate and

international rotation disruption. Those who missed out on their allocation have ample time as

the decision is made at the Board Meeting in June and the new term commences the following

February.

RR All the employment awards are transferable from state to state and in New Zealand.

SS All Cardiothoracic Surgery in Australia and New Zealand are completed in major teaching

hospitals in metropolitan and regional centres. Therefore rural attachment does not apply here.

TT Does not apply in Cardiothoracic Surgery. A policy for recognition of prior learning is in place

and approval is at the discretion of the Board.


QQ Trainees do not rotate interstate in Australia except for a small percentage that rotate through

Tasmania, NT and ACT. With ACT trainees usually request to be allocated to this network. With

NT, again trainees usually request to be rotates to Darwin or Alice Springs in order to gain

particular experience.

SS The Board attended the Rural Workshop to address this issue. The Board also provided

feedback regarding the IRTP scheme, which does not address this issue.

215



General Surgery- New Zealand

SS The New Zealand Training Committee remains supportive of applications for accreditation from

smaller hospitals, and has a number of accredited posts in centres where there are no trainees

from any other surgical specialty. Where possible opportunities for trainees in the smaller

centres, such as access to endoscopy etc., will be viewed favourably where other accreditation

criteria such as minimum logbook numbers may be marginal.


RR AOA works closely with jurisdictions to ensure processes are in place to prevent the loss of

employment benefits on rotation interstate or to a private training post

SS AOA has been working with RACS to ensure timelines for STP funding effectively align with

accreditation timelines


QQ The Board endeavours to allocate trainees their first preference for new rotations. There are no

international rotations. NSW is the only state with interstate rotations; this is to accommodate a

rural training post in Darwin and the Northern Territory. The Regional Chair of NSW makes

every effort to ensure the trainee allocated to Darwin is prepared to fill the position.

RR: The Board considers that RACS is best placed to work with jurisdictions to prevent the loss of

employment benefits when trainees transfer. The Board is working with jurisdictions to support

this endeavour.

SS The Board is not considering expansion of the program into rural and regional locations as there

are currently numerous regional locations with accredited positions.

TT The Board supports the development of common accreditation processes.

Paediatric Surgery



QQ Since 2017, 31 January was made publically known as the deadline for potential training posts

in the following year. The Australian Plastic and Reconstructive Surgery Board initially conducts

paper-based reviews to determine if a physical inspection is required. Where required, and held

before May, and if approved the training positions are added to the pool for selection the next

year.

RR RACS responsibility

SS The PRS SET training program already has several positions located outside major capital

cities (Geelong in Victoria, Launceston in Tasmania (recently approved), and rotations that

include regional centres such as Gosford in New South Wales).

The Board is also aware of regional centres exploring the requirements for accreditation

including the Sunshine Coast (QLD), Cairns (QLD), Gold Coast (QLD) and Warrnambool (VIC).

The Board supports regional positions subject to those centres meeting the accreditation

criteria. Unfortunately, a training post in Darwin was recently removed due to persistent

concerns regarding supervision.

216



The greatest barrier to regional training the lack of local workforce which is a pre-requisite to

expanding training into regional or rural locations. RACS has already commenced a process of

consultation to progress with this issue.

TT The Australian Society of Plastic Surgeons and the Australian Board have advocated for RACS

to centralise common criteria and standards for all specialties and relay these to Specialties

prior to them undertaking re-accreditation reviews.


RR Not reported to be an issue due to a Collective Employment agreement in NZ

SS Not an issue as PRS units in NZ only in main cities due to the nature of the cases treated and

existing visits to outlying town already occur and involve trainees on a regular basis.

Urology


Vascular Surgery

No significant development.


Condition 30 Mandate cultural safety training for all supervisors, clinical trainers and assessors. (Standard 8.1)

To be met by 2020



All surgical supervisors, trainers and Fellows with exposure to trainees, are required to complete all RACS

mandatory courses i.e.: FSSE, SAT SET and OWR

Neurosurgery

Nothing to report.


As a Training Board we are considering requiring this for our Education Committee. RACS should provide

generic training modules.


All surgical supervisors and trainers are required to complete all RACS mandatory courses i.e.: FSSE, SAT

SET and OWR

Paediatric Surgery

RACS to implement policy.


The refreshed curriculum (final draft December 2017) includes cultural sensitivity awareness within the

health advocacy competency. RACS to consider training standards for all Fellows.

217




No progress.

Urology

No progress.

Vascular Surgery

RACS to introduce policy.


Condition 31 In conjunction with the Specialty Training Boards, finalise the supervision standards and the process for reviewing supervisor performance and implement across all specialty training programs. (Standard 8.1)

To be met by 2021



All Surgical Supervisors, Trainers are required to complete all RACS mandatory courses i.e.: FSSE, SAT

SET and OWR

Neurosurgery

Feedback being provided to RACS.


AOA will provide comment on the Standards for Supervisors shortly.


The Board has advised RACS that it is in agreement with the Standards for Supervisors document.

Paediatric Surgery

This was discussed at BSET in June 2018. RACS to finalise standards.


June 2017 through February 2018: In development in collaboration with all Specialty Boards via the Board of

SET mechanism.


NZBPRS will provide feedback to the June BSET meeting on the Supervisor Standards document.

Urology

The Supervisor Standards have been reviewed, and through ongoing consultation with RACS, these appear

satisfactorily developed to be nearing implementation.

218



Vascular Surgery

RACS to introduce policy


Condition 32 Promote the Building Respect, Improving Patient Safety (BRIPS) program and encourage the positive participation of all fellows and trainees, including supporting all surgeons to “call out” bad behaviour in work and training. (Standard 8.2.2)

To be met by 2019



The Operating with Respect (OWR) online module is compulsory for all Fellows and trainees. The college

have also mandated the face to face OWR workshop for all Fellows. The BRIPS program is well embedded

in most teaching hospitals.

Neurosurgery

Actively promoted.


AOA continues to support the BRIPS program.


This has been complied with.


The Board has encouraged and promoted the BRIPS program by strongly advocating for the completion of

the OWR online module and face-to-face course.

Paediatric Surgery

TBC.


RACS responsibility


Completion of RACS mandated courses as part of the BRIPS campaign is a standard Agenda item for all

NZBPRS meetings. The NZBPRS has taken an active role in encouraging Fellows to meet the mandatory

requirements.

Urology

The compliance rates amongst Urology Supervisors and Trainers has been very high in terms of completion

of the mandatory training requirements as part of the BRIPS program. The Board actively encourages

fellows and trainees to report any concerns regarding inappropriate behaviour.

219



Vascular Surgery

The Board of Vascular Surgery promotes the BRIPS program among Vascular Surgery Supervisors and

Trainers.


Condition 33 In the hospital and training post accreditation standards for all surgical training programs include a requirement that sites demonstrate a commitment to Aboriginal and Torres Strait Islander and/or Māori cultural competence. (Standard 8.2.2)

To be met by 2019



No significant development. It is compulsory in all teaching hospitals in Queensland. The Board will meet in

June 2018 to implement its commitment to Aboriginal and Torres Strait Islanders and Māori cultural

awareness and competency.

Neurosurgery

Changes to the Training Post Accreditation Regulations are anticipated in July 2018 to include specific

reference for training sites to demonstrate a commitment to Aboriginal and Torres Strait Islander and/or

Māori cultural competence.


This is included as part of the hospital accreditations. We intend to add a question “does your hospital

demonstrate a commitment to Māori cultural competence?”


Accreditation standards are set by RACS. The Board would readily accept a commitment to Aboriginal and

Torres Strait Islander and/or Māori competence.

Paediatric Surgery

RACS to include in the accreditation booklet.


Planned for mid-2018 for inclusion in standardised Board inspection template and site inspection reports


From 2018 the annual SET Registrars’ weekend will include a cultural competency agenda item. We will

report more specifically in 2019. There is an intention that this becomes an annual training requirement and

we have liaised with Mr Pat Alley in the development of this. In 2018 there is a planned teaching session on

Māori pronunciation and the impact of common PRS operations, which alter the form of the body on the

Māori view of self and identity and the impact of this on individuals and whanau which NZ healthcare

providers – particularly reconstructive surgeons – need to be adept at addressing as part of the management

plan.

Urology

No progress

220



Vascular Surgery

RACS to introduce policy.

221




Areas covered by this standard: continuing professional development; further training of individual

specialists; remediation


In 2017, this set of standards was found to be Met.



UU Implement a mechanism for the newly established CPD Audit Working Group to provide more robust feedback to Fellows, with a particular focus on the breadth of surgeons’ individual practice. (Standard 9.1.3)

VV As part of the reflective practice category consider including cultural competence as an area of reflection. (Standard 9.1.3)

WW Explore the College’s role in identifying the poorly performing fellow. (Standard 9.2.1)



UU All CPD activities must have supportive documents before it is approved during the audit. This

is all entered on line via RACS.

VV Standard 9.1.3 - No major development.

WW Standard 9.2.1 - The College has the right to report an underperforming Fellow to AHPRA. This

is also linked to CPD compliance.


WW NZAGS is developing a pilot programme of practice visits which will attract CPD points for

reflective practice. It is likely that the pilot will be running later in 2018.


AOA is currently working towards addressing the recommendations of the MBA Framework within the AOA

CPD Program.

A response is currently being prepared to RACS consultation on CPD.


The NZOA CPD Programme is specific to orthopaedics. The NZOA Practice Visit Programme provides

opportunity for reflective feedback.


UU The Board would accept relevant, robust feedback to fellows concerning CPD compliance.

222



VV The Board supports cultural competence as an area of reflection and supports the College in

identifying the poorly performing Fellow.

Paediatric Surgery



Recommendations UU, VV and WW are not applicable to Australian Society of Plastic Surgeons


No progress.

Urology

No progress

Vascular Surgery



No Conditions for this standard.

223




Areas covered by this standard: assessment framework; assessment methods; assessment decision;

communication with specialist international medical graduate applicants





XX Provide greater support for specialist international medical graduate surgeons working towards specialist/vocational registration, and including access to educational resources, such as examination revision course, and other resources that are accessible to trainees. (Standard 10.2.1)

YY Make information available to future applicants that may allow them to assess the likelihood of their application achieving substantially or partially comparable status prior to them making a substantial financial payment that historical evidence might suggest is unlikely to succeed. (Standard 10.4.1)



XX and YY There have been two workshops in 2018 to address fast tracking the recognition of International

Medical Graduates. A work place assessment is proposed to recognise supervision and

Fellowship examination. A more consistent interview and evaluation process of IMGs is

currently being considered across all Specialty Boards. A full report of the workshop will be

available in due course


XX Nothing NZ specific as it is not the usual pathway


XX AOA has recently established an IMG Assessment Committee to facilitate better support of the

IMG process. The first meeting of the committee is scheduled for May 2018


XX IMGs are invited to attend the same weekly tutorials that are attended by trainees, either in

person or via webinar, in the state in which they are based. IMGs are also invited to attend the

annual OHNS trainee meeting. The process of assessment, supervision and support of

specialist IMGs working towards specialist/vocational registration is currently undergoing

rigorous review. New policies will be in place in January 2019; this information will be made

publicly available.

Paediatric Surgery


224




XX Since 2017, International Medical Graduates have reliably been sent invitation to attend state-

based educational activities as well as national SET Conferences. In 2018, five IMGs attended

the SET 2-5 Conference in Adelaide; some participated in the trial examination activity. All

participated in dissection workshops and didactic lectures. In 2016 and 2017, the SET

Conference was managed by the New Zealand Board and Society.

YY RACS responsibility as per Collaboration Agreement.


IMGs in New Zealand are managed by MCNZ. Those who apply to Fellowship are able to access information

via RACS. When the SET 2-5 PRS meeting was held in NZ in 2016 + 2017 we invited IMGs to attend (all of

those who attended were based in Australia).

Vascular Surgery



Condition 34 All College and Specialty Training Board SIMG assessment processes and associated documentation must reflect the Medical Board of Australia and Medical Council of New Zealand guidelines by ensuring that both training and post-training experience are appropriately considered in assessments of comparability. (Standard 10.1)

To be met by 2019



Work in progress.

Neurosurgery

RACS activity


The Board supports RACS’ progress in this area.

Paediatric Surgery

In progress.


In February 2017, the Board co-opted an IMG representative and established an IMG Subcommittee Panel

to coordinate the harmonisation of RACS’ IMG policies with plastic surgery standards. Feedback about

collaboration with RACS has been positive


This is managed by RACS Wellington on behalf of the MCNZ. The Board participates by joining a panel that

assess IMGs’ training and post training, education and experience referenced to FRACS; the Board reports

directly to the MCNZ.

225



Urology

The IMG representative is an active member of the IMG Committee. The Board believes that reported

progress relating to this condition should come from the IMG Committee.

Vascular Surgery

In progress.


Condition 35 Develop and adopt alternative external assessment processes, such as workplace-based assessments, to replace the Fellowship Examination for selected specialist international medical graduates. (Standard 10.2.1)

To be met by 2020



The IMG workshop will be held on 13 April 2018 to address this. A full report will be prepared.

Neurosurgery

Nothing to report.


Feedback is currently being sought from the Federal Training Committee and the new IMG Assessment

Committee on RACS proposed assessment process.


In progress through the RACS IMG committee. The Board is developing work-based assessment processes

to replace the FEX for selected IMGs.

Paediatric Surgery

In progress through the IMG committee.


As above for Condition 34.

The IMG workshops convened by RACS are a suitable and effective vehicle for bringing about change.


This should be consistent across all specialties and bi national boards for specialties such as PRS to ensure

fairness and natural justice – so we look to RACS for guidance on this.

Urology

The IMG representative is an active member of the IMG Committee. The Board believes that reported

progress relating to this condition should come from the IMG Committee.

226



Vascular Surgery

RACS – in progress

227

Leanne.Hook

Typewritten Text

Leanne.Hook

Typewritten Text

Documents

Royal Australasian College of Surgeons Progress Report